Open AccessTransplanted lungs and the “white plague”
Author(s) -
Nadim Cassir,
Robin Delacroix,
Carine Gomez,
Véronique Secq,
Martine ReynaudGaubert,
Philippe Thomas,
Laurent Papazian,
Michel Drancourt
Publication year - 2017
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000006173
Subject(s) - medicine , tuberculosis , latent tuberculosis , mycobacterium tuberculosis , immunosuppression , rifampicin , lung , transplantation , lung transplantation , genexpert mtb/rif , surgery , pathology
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.