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Paradoxical worsening of tuberculosis in a heart–lung transplant recipient
Author(s) -
Place S.,
Knoop C.,
Remmelink M.,
Baldassarre S.,
Van Vooren J.P.,
Jacobs F.,
Mascart F.,
Estenne M.
Publication year - 2007
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/j.1399-3062.2006.00194.x
Subject(s) - medicine , paradoxical reaction , tuberculosis , mycobacterium tuberculosis , immunology , lung , immune system , lung transplantation , cd8 , pathology
We report on a heart–lung transplant recipient who presented with pulmonary tuberculosis (TB) 2.5 months after transplantation and then developed a paradoxical reaction after 4 months of adequate anti‐TB treatment. She eventually recovered with anti‐TB and high‐dose steroid treatments. Methods. Using sequential bronchoalveolar lavages, we assessed the inflammatory response in the lung and investigated the alveolar immune response against a Mycobacterium tuberculosis antigen. Results. The paradoxical reaction was characterized by a massive infiltration of the alveolar space by M. tuberculosis antigen‐specific CD4 + T cells and by the presence of a CD4 − CD8 − T lymphocyte subpopulation bearing phenotypic markers (CD16 + /56 + ) classically associated with NK cells. Conclusion. This case report illustrates that even solid organ transplant recipients receiving intense triple‐drug immune suppression may be able to develop a paradoxical reaction during TB treatment. Transplant physicians should be aware of this phenomenon in order to differentiate it from treatment failure.