Gastrointestinal tuberculosis following renal transplantation accompanied with septic shock and acute respiratory distress syndrome: a survival case presentation.
BACKGROUND
Post-transplant tuberculosis (PTTB) is a serious opportunistic infection in renal graft recipients with a 30-70 fold higher incidence compared to the general population. PTTB occurs most frequently within the first years after transplantation, manifesting as pulmonary or disseminated TB. Gastrointestinal TB (GITB) is a rare and potentially lethal manifestation of PTTB and may show delayed onset in renal transplant recipients due to the use of lower doses of immunosuppressants. Further, non-specificity of symptoms and the common occurrence of GI disorders in transplant recipients may delay diagnosis of GITB.


CASE PRESENTATION
Here we report a rare survival case of isolated GITB in a renal transplant recipient, occurring seven years after transplantation. The patient's condition was complicated by severe sepsis with positive blood culture Staphylococcus haemolyticus, septic shock, multiple organ failure including acute respiratory distress syndrome (ARDS) and acute renal failure, requiring mechanical ventilation, vasopressor circulatory support and intermittent hemodialysis. Furthermore, nosocomial infections such as invasive aspergillosis and Pseudomonas aeruginosa occurred during hospitalization. Antituberculosis therapy (rifampicin, isoniazid, ethambutol and pyrazinamide) was initiated upon Mycobacterium confirmation. Moreover, treatment with voriconazole due to the Aspergillus flavus and meropenem due to the Pseudomonas aeruginosa was initiated, the former necessitating discontinuation of rifampicin. After 34 days, the patient was weaned from mechanical ventilation and was discharged to the pulmonary ward, followed by complete recovery.


CONCLUSION
This case offers a guideline for the clinical management towards survival of GITB in transplant patients, complicated by septic shock and multiple organ failure, including acute renal injury and ARDS.
['Cikova|Andrea|A|', 'Vavrincova-Yaghi|Diana|D|', 'Vavrinec|Peter|P|', 'Dobisova|Anna|A|', 'Gebhardtova|Andrea|A|', 'Flassikova|Zora|Z|', 'Seelen|Mark A|MA|', 'Henning|Robert H|RH|', 'Yaghi|Aktham|A|']
D003428:Cross Infection D005260:Female D006801:Humans D016030:Kidney Transplantation D008875:Middle Aged D009102:Multiple Organ Failure D009894:Opportunistic Infections D011183:Postoperative Complications D012128:Respiratory Distress Syndrome D012772:Shock, Septic D013997:Time Factors D016896:Treatment Outcome D014385:Tuberculosis, Gastrointestinal
Gastrointestinal tuberculosis Renal transplantation Septic shock Acute respiratory distress syndrome Multiple organ failure