신이식 후 발생한 결핵성 장천공 1예

Abstract

The risk of tuberculosis in renal transplant recipients may be related to immunosuppressive therapy, and it continues to complicate transplantation in the cyclosporine era. Extrapulmonary manifestation and dissemination also common clinical findings in the transplant recipients. Intestinal tuberculosis that develops with the involvement of other organs is common. We present a case of tuberculous intestinal perforation in the living-related donor renal transplant recipient. A 42-year-old male was admitted because of sudden onset acute abdomen. In April 1995, he received allograft kidney from HLA-identical sister following treatment with cyclosporine-A and low-dose steroids. Allograft function was stable over the next 36 months. About 3 years later, multiple cervical lymph node swelling was observed. Initial lymph node biopsy was performed, which showed granulomatous lesions with positive AFB stain. The patient was treated with antituberculous therapy regimen included isoniazid, ethambutol and rifampicin for a month. A ultrasonography and CT of the abdomen showed multiple adhesions in the peritoneum and enlargement of the mesenteric lymph nodes. A laparatomy finding was inflammatory thickening of the bowel wall in the terminal ileum with necrotic perforation. The involved terminal ileum was removed together with end-to-end anastomosis and peritoneal lavage was done. The patient was improved two weeks after surgical laparotomy.