POST-KIDNEY TRANSPLANT PULMONARY TUBERCULOSIS PRESENTING AS ASYMPTOMATIC PLEURAL EFFUSION : A ACSE REPORT

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POST-KIDNEY TRANSPLANT PULMONARY TUBERCULOSIS PRESENTING AS ASYMPTOMATIC PLEURAL EFFUSION : A ACSE REPORT

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Co-author 1

Nazik Mahmoud nazikalam2022@gmail.com Ahmed Gasim Cardiac Surgery and Renal Transplant Center Nephrology Khartoum Sudan -

Co-author 2

Jaafer Omer jaaferosman87@gmail.com Ahmed Gasim Cardiac Surgery and Renal Transplant Center Nephrology Khatoum Sudan *

Co-author 3

Mohammed Saeed mohammedelsiddigmangush@gmail.com Ahmed Gasim Cardiac Surgery and Renal Transplant Center Nephrology Khartoum Sudan -

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Introduction

Tuberculosis (TB) is a well-recognized complication in solid organ transplant recipients , with atypical presentations due to immunosuppression . Early recognition is crucial to preserve graft function and improve patients outcome . Here we present a case of post kidney transplant tuberculosis who presented atypically , but because of meticulous routine clinical evaluation , timely diagnosis has been established and proper management has been offered .

Methods

Case presentation :

A twenty four years old male who presented six weeks after a successful living -related kidney transplantation done at our Transplant Center for regular follow up visit .

During routine clinical physical examination revealed dull percussion note and decreased breath sounds on the right hemithorax . Chest X-Ray confirmed a moderate pleural effusion .The patient was completely asymptomatic with no fever , cough or weight loss . Diagnostic thoracocentesis yielded an exudative fluid and Polymerase Chain Reaction (PCR) testing was positive for Mycobacterium Tuberculosis . His complete blood count was normal , as well as his liver function test and renal profile ( his serum creatinine is 1.2 mg/dl which is his baseline ) . His inflammatory markers showed an ESR of 85mm/h and CRP of 10 .

Results

Management and Outcome :

The patient has been commenced on anti-tuberculous regimen including rifampicin , isoniazid , pyrazinamide and ethambutol . His drug regimen has been tailored to avoid significant drug-drug interaction , with close monitoring of Calcineurin Inhibitor (CNI) level with dose adjustment as required and regular graft function follow up . The patient showed good clinical response with resolution of effusion and maintained stable graft function throughout the course of his follow up .

Conclusion

This case highlights the importance of vigilance for atypical presentations of tuberculosis in kidney transplant recipients , especially in areas where tuberculosis is endemic . Routine clinical examination and early use of molecular diagnostic tests can facilitate timely diagnosis and appropriate management , preventing adverse outcomes in this high- risk population .

Kewords