POST RENAL TRANSPLANT – RARE PRESENTATION OF INTESTINAL TUBERCULOSIS.

Introduction:

Tuberculosis (TB) is a global health problem, particularly challenging in immunocompromised patients, such as those who have undergone solid organ transplants. Post-kidney transplant pulmonary tuberculosis is more commonly reported; however, extrapulmonary manifestations, particularly intestinal tuberculosis, are rare and pose significant diagnostic and therapeutic challenges. This case report describes a unique presentation of post-transplant intestinal tuberculosis, highlighting the complexities of its diagnosis and management.

Methods:

Results:

Case Report:

A 48-year-old female, who had undergone a kidney transplant in 2016, presented to our hospital with a febrile illness. Her medical history was significant for Hepatitis B virus (HBV) infection and type 2 diabetes mellitus (T2DM). She was admitted with symptoms of fever, chills, and rigor. Laboratory investigations revealed anemia, and she was diagnosed with urosepsis. She was treated with intravenous antibiotics and received packed red blood cell (PRBC) transfusions for her anemia. Although her anemia improved post-transfusion, her fever persisted. Further investigation revealed occult blood in her stool. A colonoscopy was performed, followed by a biopsy of the terminal ileum, which initially suggested Crohn's disease or ileal tuberculosis. Histopathological examination of the biopsy showed granulomatous ileitis with evidence of Mycobacterium tuberculosis, confirming the diagnosis of intestinal tuberculosis. The patient was promptly started on anti-tubercular therapy.

Conclusions:

This case shows the importance of considering tuberculosis in the differential diagnosis of persistent febrile illnesses in post-transplant patients, even when the initial presentation may suggest another condition, such as Crohn’s disease. Intestinal tuberculosis, although rare, should be suspected in immunocompromised individuals, particularly in regions where TB is endemic. Early diagnosis and prompt initiation of anti-tubercular therapy are crucial in managing such cases to prevent complications and ensure a favourable outcome.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.