Ardalan et al. Journal of Medical Case Reports 2011, 5:191 http://www.jmedicalcasereports.com/content/5/1/191 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report Mohammad R Ardalan1, Mohammadali M Shoja2 and Kamyar Ghabili2* Abstract Introduction: Tuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant. Case presentation: A 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis. Conclusion: Our case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians. Introduction Tuberculosis (TB) remains a major health hazard parti- cularly in developing countries [1]. Renal transplant recipients are at high risk of a number of infections including mycobacterial diseases [2,3]. The cumulative incidence of post-transplant TB in developing countries is as high as 13.3% with a relatively high rate of extra- pulmonary TB. Although the ileocecal region is the most affected part in gastrointestinal TB, acute tubercu- lous appendicitis is quite a rare entity [4]. Here, the authors report a renal transplant recipient who devel- oped concomitant pulmonary TB and tuberculosis appendicitis. * Correspondence: kghabili@gmail.com 2Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Full list of author information is available at the end of the article Case report A 27-year-old Iranian woman, recipient of a living, unrelated renal transplant five years earlier, presented with a productive cough, weight loss and fever. The cause of her end-stage renal disease was chronic pyelo- nephritis. Six weeks prior to her admission, her immu- nosuppressant regimen was switched from oral cyclosporine (100 mg, twice daily) to oral sirolimus (1 mg, twice daily) with a diagnosis of chronic allograft nephropathy (serum creatinine level of 2 mg/dL). Her mycophenolate mofetil dose was decreased from 2000 to 1000 mg/day and prednisolone was continued with the previous dose (5 mg, daily). Four weeks later, she devel- oped a mild cough, weakness and anorexia. Her condi- tion progressed to a more constant cough and weight loss until she was hospitalized. Physical examination revealed her blood pressure to be 110/60 mm/Hg, respiratory rate 20/min, pulse rate 92/min and body temperature 38°C. A chest © 2011 Ardalan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.