Mycobacterium tuberculosis infection of a native polycystic kidney following renal transplantation.

Tuberculosis is a recognized complication following renal transplantation. Patients with autosomal-dominant polycystic kidney disease are increasingly being offered renal transplantation as an alternative to chronic hemodialysis. These patients are uniquely susceptible to serious upper urinary tract infections that are associated with significant morbidity and mortality. While involvement with gram-negative organisms is well described, mycobacterial infection of native polycystic kidneys after transplantation has not been addressed. We report a case of a renal transplant recipient who suffered an isolated Mycobacterium tuberculosis infection of a native polycystic kidney. With a 4-drug anti-tuberculosis therapy (ATT) regimen, the patient responded and became afebrile 8 weeks after initiation of drug therapy. ATT was continued for a total of 1 year. Two years after completion of ATT, the patient enjoys a normal life and has stable graft function. M. tuberculosis, though not common, must be recognized as a potential source of infection of native polycystic kidneys in immunocompromised transplant recipients. Similar to the pattern observed with more common pathogens, these infections may be difficult to eradicate with standard antimicrobial drug regimens.