Aim/Background: High levels of immunosuppression required for intestinal transplant patients makes us alert for potentially serious infections. We present 2 patients who developed tuberculosis (TB) infection along the follow-up.

Case reports:

Patient 1: This is a 30-year-old male who presented a volvulus at 16 yo and became anenteric. Few months later, he was succesfully transplanted with an isolated intestinal graft. He was converted to Sirolimus (SRL) due to renal insufficiency and hypertension one year after transplant. Twelve years later, he was readmitted due to crhonic rejection, and was retransplanted with a multivisceral graft, with no spleen preservation, receiving Alemtuzumab for induction. He developed rejection during the postoperative period being treated with steroid bolus and higher doses of Tacrolimus. Later, he presented persistent bilateral pleural effusion requiring thoracocentesis, being positive for Adenovirus, and was treated with Brincidofovir. Three months later cultures were positive for Aspergillus and Acinetobacter refractory to medical treatment. Finally PCR for Mycobacterium TB was positive in the bronchoalveolar lavage, so quadruple therapy was initiated (Isoniazide-Rifampicin-Pyrazinamide and Etambutol) and the pleural effusion disappeared. Two months after the diagnosis, he is still on treatment and requires occasional hospital admissions to manage the mutifactorial respiratory problems.

Patient 2: This is a 28 yo female who received a modified multivisceral transplant at 17yo because of a desmoid tumor in the context of a Gardner Syndrome. She received Alemtuzumab as induction and posteriorly to manage immunological complications. She had a difficult postoperative course with severe hemolytic anemia, graft versus host disease and several episodes of acute rejection which could be succesfully managed with immunosuppressants and splenectomy. She was converted to SRL because of renal insufficiency one year after transplant. One year later, she was diagnosed of miliary TB by bone marrow punture in the context of fever of unknown origin, with no evidence of pulmonary or cerebral infiltration. Triple therapy (Isoniazide-Pyrazinamide and Etambutol) was given for several months with no recurrences until today.

Conclusions: Clinical evidence suggests to rule out subclinical Tuberculosis infection prior to intestinal transplant as part of the routine work-up in order to optimize treatments and admissions.