Tuberculosis in a renal allograft recipient presenting with intussusception

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Extra-pulmonary tuberculosis (TB) is a known complication in renal allograft recipients, often presenting atypically.
• Early diagnosis and management are crucial due to potential dissemination and unique clinical challenges.

Observation:

• A renal allograft recipient presented with persistent fever, weight loss, diarrhea, and abdominal mass 3 years post-transplant.
• The patient was diagnosed with ileocolic intussusception, which revealed granulomatous inflammation and acid-fast bacilli (AFB) consistent with Mycobacterium tuberculosis.
• Disseminated TB was confirmed by AFB detection in tracheal aspirate.

Findings:

• This is the first reported case of intestinal TB presenting as intussusception in a renal allograft recipient.
• The patient developed probable immune reconstitution inflammatory syndrome (IRIS) after initiating anti-TB therapy (ATT), leading to multiorgan failure and death.
• IRIS development post-ATT is rare in this patient population.

Implications:

• Highlights the critical need for a high index of suspicion for TB in renal transplant recipients.
• Underscores the therapeutic challenges in managing overwhelming TB infection alongside the risk of IRIS with immunosuppression reduction and ATT initiation.
• Emphasizes the importance of early diagnosis and tailored management strategies for extra-pulmonary TB in immunocompromised individuals.