A 53-year-old man with end-stage renal failure (ESRD) of unknown etiology was on hemodialysis (HD) since 1999. He underwent a first RT in 2000, with cyclosporine (CyA), mycophenolate mofetil (MMF), and prednisolone as immunosuppressive therapy. Renal graft was lost after 3 days, due to renal artery thrombosis. Second deceased kidney transplantation was performed in 2007. Both were from cytomegalovirus (CMV) positive donors and the recipient was CMV positive as well. Initial immunosuppressive therapy was daclizumab, prednisolone, MMF, and tacrolimus (TAC). In the immediate posttransplant period, there were no surgical or infectious complications, delayed graft function, or acute rejection episodes. Five months after RT, the patient had a CMV infection treated with ganciclovir with success.
Two years later, obstructive acute kidney injury was diagnosed, requiring a urological approach. Graft function stabilized to a serum creatinine (Cr) 2.3 mg/dL. 
Five years after RT, in February 2012, he was admitted with mild fever, profuse night sweating, and weight loss of 10% of his body weight, with three months of evolution. In the week prior to admission, he complained of pain in the right iliac fossa. The patient had no diarrhea, urinary symptoms, graft pain or other complaints. He had no recent travel history or known TB exposure. Analytical study revealed an elevated C-reactive protein (CRP = 70 mg/L), no anemia or leukocytosis, acute graft dysfunction, or other abnormalities. Serological study was negative, including viral hepatitis and HIV. Tuberculin skin testing was negative. Chest and abdominal X-ray and abdominal ultrasonography showed no abnormalities. Abdominal tomography (CT) was performed and showed terminal ileitis (Figure 1(a)). Colonoscopy revealed congestion and hyperemia of the ileocecal valve (ICV) with two small erosions (Figure 1(b)). ICV biopsy showed large bowel mucosa with irregularities of the surface epithelium and focal erosions, edema and congestion of the corium with mild to moderate inflammatory infiltrate. 
No viral inclusions, granulomas, or other morphological changes were identified, and Ziehl-Neelsen was negative. Polymerase chain reaction (PCR) for the diagnosis of TB on the biopsy tissue was positive.
Antituberculosis (anti-TB) therapy was started with rifampicin, isoniazid, pyrazinamide, and ethambutol, with clinical improvement. There was a need to increase by 7 times the dose of TAC, after the introduction of Rifampicin, without rejection episodes.
Nine months later, the patient is asymptomatic and the examination of the small bowel transit and colonoscopy showed no abnormalities and no evidence of reinfection.