PMC5359457_01
CT scan revealing para-aortic lymphadenopathy.
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CMV, parvovirus B-19 and EBV by quantitative polymerase chain reaction were negative. Computed tomographic imaging studies (CT) revealed periaortic lymphadenopathy (Figure 1).
(a) Liver biopsy with Hematoxylin and Eosin stain demonstrating a noncaseating granuloma. (b) Para-aortic lymph node biopsy with Acid fast stain demonstrating the presence of multiple acid fast bacilli.
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Liver biopsy revealed noncaseating granulomas and no evidence of posttransplant lymphoproliferative disorder (Figure 2(a)). Para-aortic lymph node biopsy revealed acid fast bacilli which were confirmed to be Mycobacterium tuberculosis (MTB) by nucleic acid amplification test and culture (Figure 2(b)).
Abdominal CT scan demonstrating large hypodense iliopsoas fluid collections (white arrows).
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CT scan demonstrated multiple lobulated peripherally enhancing fluid collections within the iliopsoas muscles as well as within the left hepatic lobe, most suggestive of abscesses (Figure 3).
Abdominal CT scan demonstrating resolving iliopsoas fluid collections.
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Repeat CT imaging of the abdomen revealed resolving iliopsoas fluid collections (Figure 4).
Timeline of clinical events and total lymphocyte count (diamond) from the time of transplant (red square), onset of elevated transaminases and fever (triangle), development of fever and abdominal masses (circle), rehospitalization with fever (blue square), and clinical improvement (star).
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Alemtuzumab and her immunosuppression was reduced after the diagnosis of active TB. As IRIS may occur in the setting of treatment for TB and immune reconstitution, the time course of her illness and her total lymphocyte count are displayed (Figure 5).