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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 482-483
Tuberculosis in a kidney transplant recipient diagnosed by fine needle aspiration cytology of the bone marrow

1 Transplant Research Center, Shiraz University of Medical Sciences, Iran
2 Kidney Disease Research Center, Shiraz University of Medical Sciences, Iran

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How to cite this article:
Azarpira N, Pakfetrat M. Tuberculosis in a kidney transplant recipient diagnosed by fine needle aspiration cytology of the bone marrow. Saudi J Kidney Dis Transpl 2009;20:482-3

How to cite this URL:
Azarpira N, Pakfetrat M. Tuberculosis in a kidney transplant recipient diagnosed by fine needle aspiration cytology of the bone marrow. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 26];20:482-3. Available from: https://www.sjkdt.org/text.asp?2009/20/3/482/50787
To the Editor,

Tuberculosis (TB) is one of the most important infectious diseases in humans and is endemic in many developing countries. In situations where­in the immune system becomes impaired such as acquired immune deficiency syndrome (AIDS) or organ transplant recipients who are on immu­nosuppressive drugs, tuberculosis is a major problem and the key to controlling it is rapid detection. Cytologic diagnosis of TB has been described in several previous reports; we here­with describe a renal transplant recipient in whom TB was diagnosed through bone marrow cyto­logy.

A 37 year old man underwent a kidney trans­plant and the postoperative immunosuppressive protocol consisted of cyclosporine (CsA) and steroids. The preoperative chest radiograph was normal. The postoperative course was unevent­ful for the first 10 weeks after which the patient developed fever and weight loss. Clinical exa­mination was essentially normal other than se­vere pallor. Laboratory investigations revealed he­moglobin of 5 gm/dL, leukocytes of 5.6 ×10 9 /L and platelets of 50×10 9 /L. The peripheral blood smear showed macrocytic anemia with throm­bocytopenia. Bone marrow aspiration smears showed hypercellularity with dyserythropoiesis, myeloid cells showed toxic changes and there was suppressed megakaryopoiesis. There was an increase in the number of plasma cells and macrophages with aggregates of pseudo Gau­cher cells [Figure 1]. Histologic examination of the bone marrow trephine biopsy revealed ill­defined granulomas and collection of foamy histiocytes [Figure 2]. Numerous acid fast ba­cilli (AFB) were seen on Ziehl Neelsen staining [Figure 3]. Culture for AFB, which was perfor­med by the conventional Lowenstein Jensen method, was positive. Antitubercular therapy was started for him and the fever subsided.

Transplant patients are immunosuppressed and are prone to develop various types of oppor­tunistic infections including TB; the majority of these infections are a result of reactivation of dormant disease. The prevalence of TB among renal transplant recipients varies widely in different parts of the world and ranges from < 1%in Western countries, 4-5% in the Middle East and Mediterranean to nearly 15% in India. [1],[2],[3],[4],[5] The most common presentation of TB is pleuro­pulmonary involvement; however, the frequency of extra pulmonary TB is higher in organ trans­plant recipients. In patients with TB, cytologic smears show increase in the number of plasma cells and macrophages with aggregates of pseudo Gaucher cells, but these finding are not patho­gnomonic. [5],[6] The histologic hallmark of TB is the centrally necrotic granuloma, or "tubercle". In some occasions, non caseating granulomas are also seen. Acid fast stains reveal the classic long, slightly curved, beaded rods characteristic of Mycobacterium tuberculosis. In addition to acid fast stains, immunoperoxidase methods and molecular methods are now available for confirmation of Mycobacterium tuberculosis infection in suspected tissues. Culture identifi­cation along with sensitivity studies remains the gold standard for this diagnosis. [5],[6] Early diag­nosis and treatment are important in these patients. Bone marrow aspiration cytology is a very useful, rapid, sensitive and inexpensive investigative procedure for the diagnosis of TB in such patients.

   References Top

1.Lui SL, Tang S, Li FK, et al. Tuberculous infection in southern Chinese renal transplant recipients. Clin Transplant 2004;18(6):666-73.  Back to cited text no. 1    
2.Wang B, Lu Y, Yu L, Liu C, Wu Z, Pan C. Diagnosis and treatment for tuberculosis infec­tion in liver transplant recipients: Case reports. Transplant Proc 2007;39(10):3509-11.  Back to cited text no. 2    
3.Higgins RM, Cahn AP, Porter D, et al. Myco­bacterial infections after renal transplantation. Q J Med 1991;78:145-5.  Back to cited text no. 3  [PUBMED]  
4.Queipo JA, Broseta E, Santos M, Sanchez­Plumed J, Budia A, Jimenez-Cruz F. Myco­bacterial infection in a series of 1261 renal transplant recipients. Clin Microbiol Infect 2003;9(6):518-25.  Back to cited text no. 4    
5.Prasoon D. Acid fast stain in fine needle aspiration smears from tuberculous lymph nodes. Acta Cytolol 2000;44:297-300.  Back to cited text no. 5    
6.Basu D, Nilkund J. Detecting mycobacteria in Romanowsky --stained cytologic smears. Acta Cytol 2003;47(5):774-6.  Back to cited text no. 6    

Correspondence Address:
Negar Azarpira
Transplant Research Center, Shiraz University of Medical Sciences
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PMID: 19414959

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