Gastrointestinal tuberculosis following renal transplantation accompanied with septic shock and acute respiratory distress syndrome: a survival case presentation

BMC Gastroenterology

Case Report

Robert H. Henning¹  Mark A. Seelen²  Peter Vavrinec³  Diana Vavrincova-Yaghi³  Zora Flassikova⁴  Andrea Gebhardtova⁴  Aktham Yaghi⁴  Anna Dobisova⁴  Andrea Cikova⁴ 

[1] Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Odbojarov 10, 832 32, Bratislava, Slovakia;University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia;

关键词: Gastrointestinal tuberculosis;    Renal transplantation;    Multiple organ failure;    Acute respiratory distress syndrome;    Septic shock;   

DOI  :  10.1186/s12876-017-0695-5

 received in 2017-07-19, accepted in 2017-11-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPost-transplant tuberculosis (PTTB) is a serious opportunistic infection in renal graft recipients with a 30-70 fold higher incidence compared to the general population. PTTB occurs most frequently within the first years after transplantation, manifesting as pulmonary or disseminated TB. Gastrointestinal TB (GITB) is a rare and potentially lethal manifestation of PTTB and may show delayed onset in renal transplant recipients due to the use of lower doses of immunosuppressants. Further, non-specificity of symptoms and the common occurrence of GI disorders in transplant recipients may delay diagnosis of GITB.Case presentationHere we report a rare survival case of isolated GITB in a renal transplant recipient, occurring seven years after transplantation. The patient’s condition was complicated by severe sepsis with positive blood culture Staphylococcus haemolyticus, septic shock, multiple organ failure including acute respiratory distress syndrome (ARDS) and acute renal failure, requiring mechanical ventilation, vasopressor circulatory support and intermittent hemodialysis. Furthermore, nosocomial infections such as invasive aspergillosis and Pseudomonas aeruginosa occurred during hospitalization. Antituberculosis therapy (rifampicin, isoniazid, ethambutol and pyrazinamide) was initiated upon Mycobacterium confirmation. Moreover, treatment with voriconazole due to the Aspergillus flavus and meropenem due to the Pseudomonas aeruginosa was initiated, the former necessitating discontinuation of rifampicin. After 34 days, the patient was weaned from mechanical ventilation and was discharged to the pulmonary ward, followed by complete recovery.ConclusionThis case offers a guideline for the clinical management towards survival of GITB in transplant patients, complicated by septic shock and multiple organ failure, including acute renal injury and ARDS.

【 授权许可】

CC BY   
© The Author(s). 2017