28353558 Visualization

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