Extrapulmonary Latent Tuberculosis Reactivation After Negative Screening Tests in a Liver Transplant Recipient.

Background: Posttransplant tuberculosis (TB) is an uncommon complication following liver transplantation (LT). Given its high mortality, it is advocated to screen for latent TB with tuberculin skin test (TST), interferon [gamma] release assay and/or chest radiography before LT. Case Report: A 52-year-old Filipino gentleman was admitted with an 8-week history of abdominal pain, hematochezia, and weight loss. His pre-LT screening for latent TB with TST and chest radiography was negative. Colonoscopy revealed an ulcerated polypoid lesion in the terminal ileum. The cause of ulceration was histologically indeterminate. Because a lymphoproliferative disorder was suspected, a right hemicolectomy was done during which hard white studding was noted in the distal small bowel. Induration and a mass formation in the terminal ileum and the cecum were also seen. Histopathology showed necrotizing granulomas. Stain for acid-fast bacilli was negative. The strong suspicion for TB prompted us to obtain a chest computed tomography scan, which showed calcified perivascular and left hilar lymph nodes reflecting prior granulomatous disease. QuantiFERON-TB Gold In-Tube Test was positive. Treatment with standard anti-TB regimen was initiated. Two weeks later, cultures from intestinal tissue grew Mycobacterium tuberculosis. The patient reported a complete resolution of his symptoms at 3-month follow-up. Conclusions: Chest computed tomography scan and interferon [gamma] release assays in conjunction with TST and chest radiograph may improve the detection of latent TB in transplant candidates. Combining these tests to diagnose latent TB is a strategy that needs to be evaluated in future studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2vm5Jca