A 53-year-old woman, inactive carrier of hepatitis B and ESRD secondary to membranoproliferative glomerulonephritis, was on HD since 1984. She underwent a deceased kidney transplantation in 2007, (CMV donor+/recipient+). Initial immunosuppressive therapy was daclizumab, prednisolone, MMF, and TAC. There were no delayed graft function, acute rejection episodes, and surgical or infectious complications and renal allograft function remained normal.
Three years after RT, in February 2010, an episode of intestinal obstruction was documented and assumed as secondary to adhesions. Laparotomy was performed and showed few small bowel and colon loops with a whitish appearance and nodular structures of 5 mm in diameter along the ICV. Partial resection of the ileum was done. Histological examination revealed nonnecrotizing epithelioid granulomas in the ileum's subserosa (Figures 2(a) and 2(b)) and a mesenteric nodule showed a necrotizing nongranulomatous inflammation, and Ziehl-Neelsen was negative. After a short period of paucity of abdominal complaints, the patient suffered low-grade fever, pain in the lower abdomen, alternating constipation, and no hemorrhagic diarrhea.
Two months later, in April 2010, she was readmitted with high fever (38.8 C), anorexia, and diffuse abdominal tenderness, especially at the right iliac fossa. Analytic study revealed leukocytosis (12.750/muL), elevated CRP (58 mg/L), without renal graft dysfunction or other abnormalities. Prior pathologic analysis of the intestine was reviewed and PCR analysis was positive for MT. A quadruple therapy consisting of rifampicin, isoniazid, pyrazinamide and ethambutol was started, with favorable evolution. There was a need to increase dose of TAC by 5 times, with no rejection episodes. Six months after anti-TB therapy, small bowel transit and colonoscopy showed no pathological changes. After anti-TB therapy suspension, the patient is asymptomatic, with no signs of reinfection.