Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient

TY - JOUR

T1 - Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient

T2 - A case report

AU - Schmidt-Lauber, Christian

AU - Jacobi, Johannes

AU - Polifka, Iris

AU - Hilgers, Karl F

AU - Wiesener, Michael S

PY - 2019/9

Y1 - 2019/9

N2 - RATIONALE: Active tuberculosis constitutes a relevant risk for kidney transplant recipients. In contrast to immunocompetent hosts, kidney transplant recipients often show atypical presentation and course of the disease impeding diagnosis. Especially extrapulmonary or disseminated infection is more frequent and can resemble malignant processes. However, reactivation of tuberculosis mostly develops within the early post-transplant course, whereas malignancies are predominantly long-term complications. We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature.PATIENT CONCERNS AND DIAGNOSES: A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and stool and disseminated abdominal tuberculosi was diagnosed.INTERVENTIONS AND OUTCOMES: With anti-tuberculosis therapy, the masses regressed, and all cultures became sterile, sparing graft function.LESSONS: This case emphasizes how variable and unspecific the presentation of tuberculosis in kidney transplant recipients may be and that tuberculosis constitutes a relevant risk also in the long-term post-transplant course.

AB - RATIONALE: Active tuberculosis constitutes a relevant risk for kidney transplant recipients. In contrast to immunocompetent hosts, kidney transplant recipients often show atypical presentation and course of the disease impeding diagnosis. Especially extrapulmonary or disseminated infection is more frequent and can resemble malignant processes. However, reactivation of tuberculosis mostly develops within the early post-transplant course, whereas malignancies are predominantly long-term complications. We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature.PATIENT CONCERNS AND DIAGNOSES: A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and stool and disseminated abdominal tuberculosi was diagnosed.INTERVENTIONS AND OUTCOMES: With anti-tuberculosis therapy, the masses regressed, and all cultures became sterile, sparing graft function.LESSONS: This case emphasizes how variable and unspecific the presentation of tuberculosis in kidney transplant recipients may be and that tuberculosis constitutes a relevant risk also in the long-term post-transplant course.

KW - Antitubercular Agents/therapeutic use

KW - Colonic Neoplasms/diagnosis

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Kidney Transplantation

KW - Middle Aged

KW - Postoperative Complications/diagnosis

KW - Tuberculosis, Gastrointestinal/diagnosis

U2 - 10.1097/MD.0000000000016995

DO - 10.1097/MD.0000000000016995

M3 - Case report

C2 - 31490381

VL - 98

SP - e16995

JO - MEDICINE

JF - MEDICINE

SN - 0025-7974

IS - 36

ER -