Tuberculous sacroiliitis in a renal transplant recipient: a case report

Although Mycobacterium tuberculosis (TB) is the predominant infectious disease after solid organ transplantation worldwide, extrapulmonary involvement in the sacroiliac (SI) joint has never been reported in renal transplant patients. Herein we have described a 59-year-old man who presented with left hip pain and fever at 1 year after renal transplantation. He had a positive Patrick's test on the left hip, elevated serum C-reactive protein, and widening of left SI joint on pelvic radiograph. Although the initial workup including blood culture, acid-fast stain, and tumor markers was nonrevealing, whole body bone scan and magnetic resonance imaging were suggestive of left sacroiliitis. Surgical debridement with biopsy confirmed mycobacterium TB infection. After a complete course of anti-TB treatment, his symptoms significantly resolved. Given the inconspicuous and protean symptoms of extrapulmonary TB, a high index of suspicion for TB sacroiliitis in renal transplant recipients with unexplained hip pain is warranted for early diagnosis and prompt treatment.