TUBERCULOSIS OF THE SMALL-BOWEL WITH PERFORATION AND HEMATOGENOUS SPREAD IN A RENAL-TRANSPLANT RECIPIENT

A 41-year-old male was admitted because of acute abdomen. A flat plate of the abdomen suggested pneumoperitoneum and a chest X-ray an infilt rate in the right upper lobe. The patient was a renal allograft recipi ent and was on immunosuppressive therapy with azathioprin, cyclosporin e and steroids. At laparatomy inflammatory thickening of the bowel wal l was found in the terminal ileum with necrotic areas and two sites of perforation. The involved terminal ileum was removed together with a right hemicolectomy. The resected segment showed exudative ileal tuber culosis and fibrinous and purulent peritonitis. During the postoperati ve period rapid hematogenous spread of tuberculosis developed with pro gressive reduction of respiratory function followed by ARDS. Autopsy r evealed tuberculosis in all organs including the transplanted kidney.