Miliary Tuberculosis and CMV Infection in a Kidney Recipient

Cytomegalovirus (CMV) is the leading cause of infectious complications after organ transplantation. Tuberculosis can occur in the early postoperative period and is potentially curable. We report here a 45-year-old renal transplant recipient with a rare coinfection of CMV infection and miliary tuberculosis, as early as 6 months after the transplant. In addition, HCV Ab was positive with normal liver function tests before kidney transplantation. The organism was isolated from sputum and broncoalveolar lavage (BAL) specimen cultures. The patient was given 12 months of quadruple anti-TB therapy. With antituberculous therapy, and reduction in the patient's conventional immunosuppression, intravenous ganciclovir was also used. The patient remained disease-free after a follow-up period of 6 years.

To our knowledge, this is the first case report of a coinfection with cytomegalovirus and Mycobacterium tuberculosis presenting with pulmonary miliary pattern. In addition, administration of steroid boluses, CMV and HCV infections are important risk factors for TB in our patient.

 In conclusion: Post-transplant TB is a serious problem worldwide, and must be always included in the differential diagnosis of fever and pulmonary disease in the renal transplant recipient. Early diagnosis and prompt initiation of treatment for TB among renal transplant patients is very important and vital.