Tuberculosis (tbc) is a rarely seen opportunistic infection after liver transplantation (LT). Tbc incidence was reported as 2.4% (6/254) in pediatric LT recipients in United Kingdom. Here we presented a case of tbc lymphadenitis occurred in 1 out of 109 (0.9%) children who underwent LT between September 2001- March 2008 in our hospital. Case A left lateral segment of her mother’s liver was transplanted to the 7 months old patient with the diagnosis of PFIC-2. She had BCG vaccine when she was 1 months old. Her PPD test and EBV IgG was negative before LT. 16 months after LT she had primary EBV infection. Her EBV viral load was 4.8x105 copies/mL. Tacrolimus dose was decreased and oral acyclovir was prescribed for this reason. Three months later, she presented with high fever, cough, weight loss, and sweating. On physical examination bilateral hard submandibular lymphadenopathies were palpated. Her erythrocyte sedimentation rate was 95mm/h; CRP was 97.4 mg/dl. Ultrasonography demonstrated multiple lympadenopathies at bilateral cervical chain and submandibular areas. She underwent submandibular lymph node tru-cut biopsy with the possible diagnosis of EBV-related post transplantation lymphoproliferative disease (PTLD). Surprisingly pathological diagnosis was granulomatous lymphadenitis. Multiple acid-fast bacilli were demonstrated in the lymph node. Mycobacterium tuberculosis grew in gastric juice. Her chest X-ray and thorax tomography were normal. Her family screened and no tbc cases could be identified. Streptomycin (2 months, intramuscular), pyrazinamide (2 months), isoniazid (1 year) and rifampicine (1 year) were started. She was kept on tacrolimus treatment. At the end of tbc treatment her lymph nodes became smaller and no hepatotoxicity developed. Conclusion: In children our knowledge about presentation, diagnosis and treatment of tbc after LT is limited. Tbc lymphadenitis should be in the differential diagnosis of enlarged lymph nodes in liver transplanted children.
Volume : 6
Issue : 4
Pages : 199
Department of Pediatric Gastroenterology, Baskent University Faculty of Medicine, Ankara, Turkey