Recurrence of ANCA-Associated Vasculitis After Kidney Transplantation in a Patient With Pulmonary Tuberculosis: A...

Recurrence of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after kidney transplantation is uncommon and has become less frequent with modern immunosuppressive strategies. However, infections and modulation of immunosuppression may act as potential triggers for disease reactivation. We report the case of a 28-year-old male kidney transplant recipient with end-stage renal disease secondary to granulomatosis with polyangiitis (GPA). One year prior to transplantation, he had a low-titer C-ANCA positivity, with no subsequent ANCA measurements until the current admission. Six years after transplantation, the patient developed pulmonary tuberculosis and required antituberculous therapy, during which tacrolimus serum concentrations decreased significantly. Despite partial clinical improvement, he presented with persistent fever, progressive allograft dysfunction, hematuria, proteinuria, and elevated serum C-ANCA. Kidney allograft biopsy revealed pauci-immune crescentic glomerulonephritis, consistent with recurrent GPA. Immunosuppressive intensification with corticosteroids and cyclophosphamide, followed by rituximab, resulted in improvement of renal function without infectious deterioration, while antituberculous therapy was successfully completed. This case highlights that recurrence of AAV should be considered in the evaluation of kidney allograft dysfunction, particularly in the context of infection and immunosuppressive modulation. With careful monitoring and individualized management, vasculitis recurrence can be effectively treated even in the presence of active tuberculosis.