alexa Esophageal Tuberculosis Infection in a Simultaneous Pan
ISSN: 2327-5146

General Medicine: Open Access
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Case Report

Esophageal Tuberculosis Infection in a Simultaneous Pancreas and Kidney Transplant Recipient

S Rahmatulla1, A Marshall2, S Bhagani3, GL Jones1 and DP Gale1*
1Centre for Nephrology, Royal Free Hospital, University College London, UK
2Centre for Gastroenterology, Royal Free Hospital, London, UK
3Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
Corresponding Author : Daniel P Gale
Centre for Nephrology, Royal Free Hospital
University College London, NW3 2PF, UK
Tel: 02078302695
Fax: 02073178591
E-mail: [email protected]
Received May 22, 2014; Accepted June 30, 2014; Published August 20, 2014
Citation: Rahmatulla S, Marshall A, Bhagani S, Jones GL, Gale DP (2014) Esophageal Tuberculosis Infection in a Simultaneous Pancreas and Kidney Transplant Recipient. Gen Med (Los Angel) 2:144. doi: 10.4172/2327-5146.1000144
Copyright: © 2014 Rahmatulla S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Solid organ transplant recipients are at increased risk of opportunistic infections, including tuberculosis, which may be caused by re-activation of latent disease or acquired de novo. Tuberculosis can affect any organ, present atypically, is diagnostically challenging and potentially fatal. Esophageal tuberculosis is generally rare, and usually secondary to infection in adjacent mediastinal structures. We report a case of esophageal tuberculosis in a simultaneous pancreas-kidney transplant recipient, who presented with symptoms of odynophagia, retrosternal chest pain, weight loss and dry cough, three years post-transplantation. Initial upper gastrointestinal endoscopy revealed non-specific inflammation but no identifiable cause. Repeat endoscopy revealed severe ulceration with a lower esophageal stricture. Multiple esophagealbiopsies taken demonstrated granulomatous inflammation, and evidence of acid-fast bacilli on Ziehl- Neelsen staining. Polymerase Chain Reaction (PCR) assay was specific for Mycobacterium tuberculosis. Computerized tomography (CT) of the patient’s thorax showed evidence of pulmonary disease and fully sensitive Mycobacterium tuberculosis was cultured from the esophageal tissue biopsies, confirming a diagnosis of secondary esophageal tuberculosis.The patient was treated with 6 months of anti-tuberculous therapy, following which she had made a full recovery. This case illustrates firstly an unusual manifestation of tuberculosis in an immunocompromised patient; secondly the importance of thorough and persistent investigation of unexplained symptoms in this group; and thirdly that tuberculosis should always be considered as it may occur even in patients who do not fulfill conventional criteria for prophylactic therapy.

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