UNUSUAL MANIFESTATIONS OF TUBERCULOSIS IN CYCLOSPORINE-TREATED RENAL-TRANSPLANT RECIPIENTS

Tuberculosis has been observed to occur with a higher frequency in renal transplant recipients compared with the general population. This retrospective review of tuberculosis in cyclosporine-treated renal transplant recipients over the past 5 years was conducted to evaluate the incidence of the disease, its common manifestations and the efficacy of treatment. Medical record review was carried out to identify recipients of renal transplants who were treated for tuberculosis over the past 5 years. Five patients were identified. Their case reports constitute the substance of this review. The incidence of tuberculosis in our population of renal transplant recipients is approximately 0.5%. Manifestations of the disease which are apparent in all 5 cases include extrapulmonary manifestations of the infection, delay of at least a year in the development of tuberculosis from the time of transplantation and, finally, prior immigration by the patients to the United States from foreign countries in which tuberculosis is more prevalent. We conclude that tuberculosis continues to complicate renal transplantation in the cyclosporine era. A high index of suspicion for this disease should be exercised when evaluating patients with evidence of pulmonary and extrapulmonary infections, especially in the late post-transplant period.