Cutaneous Tuberculosis in Heart Transplant.

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Dermatology

Background:

• Tuberculosis (TB) poses a significant global health challenge, primarily affecting the lungs but capable of extrapulmonary manifestations.
• Immunosuppressed individuals, such as organ transplant recipients, face heightened risks for TB and often exhibit atypical disease presentations.
• Cutaneous tuberculosis is rare, accounting for approximately 2% of extrapulmonary TB cases.

Observation:

• A heart transplant recipient presented with disseminated tuberculosis manifesting as multiple cutaneous abscesses, initially misdiagnosed as a bacterial infection.
• Diagnosis was confirmed by nucleic acid amplification testing and Mycobacterium tuberculosis cultures from abscess drainage.
• The patient experienced two episodes of immune reconstitution inflammatory syndrome (IRIS) during antituberculous treatment.

Findings:

• IRIS episodes were attributed to a combination of factors: reduced immunosuppression, drug interactions between rifampin and cyclosporine, and the initiation of TB treatment.
• The patient's condition improved with enhanced glucocorticoid therapy.
• No signs of treatment failure were observed after six months of antituberculous therapy.

Implications:

• This case highlights the importance of considering disseminated tuberculosis in immunosuppressed patients with unusual skin lesions.
• Awareness of potential drug interactions and the risk of IRIS is critical for managing TB in transplant recipients.
• Prompt diagnosis and tailored treatment strategies, including careful immunosuppression management, are essential for favorable outcomes.