Diagnosis and Therapeutic Challenges of Drug-Resistant Tuberculosis Infection After Kidney Transplantation: A Rare Case Report
Abstract
Background Kidney transplant recipients are at high risk for tuberculosis (TB), particularly drug-resistant forms, due to prolonged immunosuppressive therapy. The diagnosis and treatment of TB in this population pose unique challenges, including infection control, graft protection, and drug interactions. Case Presentation We report the case of a 28-year-old male kidney transplant recipient was diagnosed with pulmonary TB four months post-transplantation. The patient self-discontinued initial anti-TB therapy after one month, leading to relapse nine months later, with confirmed rifampicin resistant. Following three months of treatment with a second-line regimen including linezolid, he developed disseminated skeletal TB, with drug susceptibility testing indicating linezolid resistance. The treatment was adjusted to an all-oral regimen including isoniazid, moxifloxacin, clofazimine, cycloserine, and bedaquiline, resulting in significant clinical and radiological improvement. Discussion In the present case, the patient’s non-adherence to the medication regimen resulted in initial treatment failure. Against the backdrop of immunosuppression, rifampicin resistance emerged rapidly. Although the subsequent linezolid-containing regimen was administered for a short duration, it likely triggered ribosomal target mutations—leading to linezolid resistance and hematogenous dissemination to the bone—driven by both drug selection pressure and the history of irregular treatment. Confronted…
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