Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2017; 7(3): 213-221
Published online Jun 24, 2017. doi: 10.5500/wjt.v7.i3.213
Tuberculosis in kidney transplant recipients: A case series
Manish Anand, Ekta Nayyar, Beatrice Concepcion, Megha Salani, Heidi Schaefer
Manish Anand, Department of Medicine, Division of Nephrology, University of Cincinnati, Cincinnati, OH 45221, United States
Ekta Nayyar, Trihealth Infectious Disease, Good Samaritan Hospital, Cincinnati, OH 45220, United States
Beatrice Concepcion, Megha Salani, Heidi Schaefer, Department of Medicine, Division of Nephrology, Vanderbilt University, Nashville, TN 37232, United States
Author contributions: All authors contributed to the acquisition of data, drafting the article, and making critical revisions related to the content of the manuscript.
Institutional review board statement: This case report was exempt from Institutional Review Board Standards at Vanderbilt University at Nashville.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Heidi Schaefer, MD, Associate Professor of Medicine, Department of Medicine, Division of Nephrology, Vanderbilt University, 1161 21st Avenue South, Nashville, TN 37232, United States.
Telephone: +1-615-3226976 Fax: +1-615-9360695
Received: October 25, 2016
Peer-review started: October 28, 2016
First decision: December 1, 2016
Revised: January 14, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: June 24, 2017

Solid organ transplant recipients have an elevated risk of tuberculosis (TB) with high mortality. Data about TB in this population in the United States is sparse. We present four cases of active tuberculosis in kidney transplant recipients at our center. All patients had possible TB exposure prior to transplant and all were diagnosed with active TB within the first year of transplant. Disseminated TB was seen in half of the patients with extra-pulmonary TB being more common affecting lymph nodes, pericardium, and the kidney allograft. Delay in diagnosis from onset of symptoms ranged from fifteen days to two months. Two patients died from TB. TB is a largely preventable and curable disease. However, challenges remain in the diagnosis due to most recipients presenting with atypical symptoms. Physicians should maintain a high degree of suspicion for TB to promptly diagnose and treat post-transplant thereby minimizing complications. A review of the literature including the epidemiology, pathogenesis, clinical presentation, diagnosis and treatment options are discussed.

Keywords: Mycobacterium tuberculosis, Kidney transplant, Disseminated disease, Tuberculosis

Core tip: Tuberculosis is a largely preventable and curable disease that should be suspected in all solid organ transplant recipients who present with unexplained fevers, pulmonary or extra-pulmonary symptoms. This case report describes the varied presentations of tuberculosis in kidney transplant recipients and provides the most recent recommendations regarding diagnosis and treatment.