Isolated skin ulcers due to Mycobacterium tuberculosis in a renal allograft recipient

Tuberculosis is a serious opportunistic infection in renal transplant recipients. Post-transplantation tuberculosis most commonly occurs within the first few years of receipt of a renal allograft, but Ram et al. present the case of a 27-year-old male who presented with isolated skin ulcers caused by Mycobacterium tuberculosis 12 years after kidney transplantation. They review the literature on post-transplantation tuberculosis and discuss treatment options. Background A 27-year-old male renal allograft recipient presented to hospital with isolated skin ulcers on both lower limbs. At presentation, he also had a low-grade continuous fever, malaise and anorexia. Investigations Physical examination, laboratory studies, histopathological examination of tissue biopsy samples from the ulcer edges and ulcer floor, culture of the biopsy tissue, chest radiograph, bone marrow biopsy, abdominal ultrasound, tuberculin skin test and examination of three early morning samples of gastric juice and urine for acid-fast bacilli. Diagnosis Isolated cutaneous ulcers caused by Mycobacterium tuberculosis. Management Four-drug antituberculosis therapy with pyrazinamide, of loxacin, ethambutol and isoniazid.