Donor-Derived Disseminated Mycobacterium Tuberculosis Infection in a Lung Transplant Recipient Three Months After Transplant

Introduction

Reactivation of latent mycobacterium tuberculosis (MTB) infection in lung transplant recipients is common, which is why pre-transplant screening is recommended to guide treatment. However, MTB transmission from a donor organ is much rarer and there is no consistent screening process of donors. We describe a consequence of this, a rare case of donor-derived disseminated MTB infection in a bilateral lung transplant (BLTx) recipient.

Case Report

A 61-year-old female three months post BLTx complicated by post-operative right lung torsion requiring pneumonectomy presented with a swollen and tender right index finger, tender nodules along her occiput, and a recurrent left sided pleural effusion, which was drained on presentation and culture negative. She improved initially with linezolid and ceftriaxone for presumed septic arthritis, however re-presented two weeks later with similar features, which prompted further evaluation. CT and subsequently MRI of the abdomen demonstrated multiple rim-enhancing liver lesions. A finger aspirate and liver biopsy were obtained that were both culture and smear positive for MTB. Sputum acid fast bacilli samples were negative, and she was started on quadruple therapy with rifabutin, isoniazid, pyrazinamide, and ethambutol with clinical improvement, including resolution of her culture-negative pleural effusion. We suspect that this was a donor-derived infection as the donor lived in an endemic region for many years and the recipient was latent TB negative pre-transplant.

Summary

Donor-derived MTB infection can be difficult to diagnosis due to the atypical way it can present, especially in patients who reside in non-endemic areas. As the world becomes more globalized, and access to lung transplant more accessible, we believe that more donor organs will come from individuals who have lived in endemic areas increasing the risk of donor-derived MTB infections making this an important diagnosis to consider.