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+A 41-year-old Caucasian woman underwent a primary double lung transplantation for cystic fibrosis in 2006.
+Her medical history was otherwise unremarkable and the patient had no known history of pulmonary tuberculosis or tuberculosis contact.
+On December 2015, she underwent retransplantation for chronic lung allograft dysfunction.
+During the month preceding retransplantation, 4 sputum specimens remained negative for acid-fast bacilli and specific M. tuberculosis culture and real-time polymerase chain reaction (PCR) testing.
+On postoperative day 42, deterioration of her respiratory status prompted a chest-computerized tomography (CT) scan revealing sub-centimeter bilateral nodules primarily located in the apical posterior lobes and a bilateral pleural effusion (Fig.1).
+The same day, a bronchoalveolar lavage (BAL) yielded a positive real-time PCR for rifampicin-susceptible M. tuberculosis, confirmed by culture on postoperative day 62.
+Tuberculin skin test (TST) or interferon-γ release assay (IGRA) test were not performed.
+All the BALs performed on postoperative period yielded no other pathogen except for the one performed on day 60 that cultured Pseudomonas aeruginosa; the adjunctive antibiotic therapy was imipenem-cilastatin, 3 g/d.
+Histological examination of a lung biopsy performed 6 weeks after retransplantation revealed a caseating granuloma and necrosis.
+Acid-fast bacilli were identified as rifampicin-susceptible M. tuberculosis by real-time PCR.
+On postoperative day 65, the patient's status worsened with severe hypoxemia, shock unresponsive to high dose cathecolamines, and multiorgan failure.
+The patient died on postoperative day 70, despite treatment combining isoniazid, rifampicin, ethambutol, and pyrazinamide.
+Retrospective real-time PCR testing of the explanted lung and BALs performed on postoperative days 1, 7, and 21 remained negative.
+The organ donor died of posttraumatic intracerebral hemorrhage.
+He was a 47-year-old man with no history of lung disease or risk factors for tuberculosis other than chronic alcohol use and smoking.
+TST results were not available.
+During hospitalization, a lung CT-scan showed no signs of active or previous tuberculosis and no TST or IGRA test results were available.
+Routine cultures of per-transplantation right lung biopsy yielded Candida albicans.
+Retrospective M. tuberculosis real-time PCR yielded negative results on the left and right donor-lung biopsies.
+Both kidneys from the same donor were transplanted into 2 other recipients.
+Six months after transplantation, neither of the kidney recipients had developed any signs or symptoms suggestive of active tuberculosis.