Transplanted lungs and the “white plague”: A case-report and review of the literature

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Abstract

Rationale:

Solid organ transplant recipients, especially after lung transplantation, are at increased risk for Mycobacterium tuberculosis pulmonary tuberculosis due to lifelong immunosuppression.

Patient concerns:

A 41-year-old woman underwent a second bilateral lung transplantation that was complicated by fatal pulmonary tuberculosis.

Diagnoses:

Histological examination of a lung biopsy performed 6 weeks after retransplantation revealed a caseating granuloma and necrosis. Acid-fast bacilli were identified as rifampicin-susceptible M. tuberculosis by real-time polymerase chain reaction (PCR), confirmed by culture 2 weeks later.

Interventions:

Our investigation led us to highly suspect that the transplanted lungs were the source of M. tuberculosis transmission.

Lessons:

In order to optimize diagnosis and treatment for lung recipients with latent or active tuberculosis, regular assessment of lower respiratory samples for M. tuberculosis, particularly during the 12-month period posttransplant should be implemented. Regarding donor-derived transmission, screening donor grafts with latent tuberculosis by M. tuberculosis real-time PCR in lymphoid and adipose tissues is an option that should be considered.

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