[Tuberculosis following liver transplantation].

Area of Science:

• Medicine
• Transplantation
• Infectious Diseases

Background:

• Orthotopic liver transplantation is a life-saving procedure for end-stage liver disease.
• Post-transplant immunosuppression increases susceptibility to opportunistic infections like tuberculosis.
• Managing co-existing conditions such as tuberculosis requires careful consideration of treatment protocols.

Observation:

• A 55-year-old patient developed pulmonary tuberculosis seven months after liver transplantation for postnecrotic cirrhosis.
• Symptoms included fever, cough, and a left upper lobe lung infiltration.
• Sputum culture confirmed Mycobacterium tuberculosis infection.

Findings:

• The patient was treated with ethambutol and isoniazid.
• Tuberculosis resolved within eleven months with minor residual effects.
• Liver transplant function remained excellent by the fourth year post-operation.
• A reversible increase in liver enzymes was the primary noted side effect.

Implications:

• Hepatotoxic anti-tuberculosis drugs, particularly rifampicin, should be avoided in liver transplant patients.
• Dosage of anti-tuberculosis medications must be adjusted based on liver function to preserve graft integrity.
• This case highlights the importance of vigilant monitoring and tailored treatment strategies for tuberculosis in liver transplant recipients.