Tuberculous pneumonia complicating lung transplantation: case report and review of the literature.

Although tuberculosis is more common in transplant recipients than in the general population, most centres report that mycobacterial infection is very rare in comparison with the extreme variety of transplant-associated infections. Only 18 previous cases of tuberculosis-complicated lung or heart-lung transplants have been published. An unusual case is reported of Mycobacterium tuberculosis infection in a double-lung recipient who presented a radiographic feature of segmental pneumonia, mimicking a bacterial infection. Bronchoalveolar lavage revealed lymphocytosis (> 30% of isolated cells). Data regarding optimal treatment for tuberculosis in lung transplant recipients are limited. Nevertheless, therapy should not be different from that in other immunocompromised patients and should include an aggressive initial four-drug regimen (until the sputum cultures become negative) or a 6-month conventional therapy with two agents to which the organism is susceptible. Close follow-up is required to confirm the bacteriological response and minimize the likelihood of relapse. In this patient, treatment with a four-drug antituberculous regimen for 3 months followed by isoniazide and rifampicin for an additional 9 months was curative.