Intestinal Tuberculosis in a Liver Transplant Patient

A 52 year-old Filipino male with a past medical history of Hepatitis B and C, who underwent orthotopic liver transplantation in 2009, was admitted three years post-transplant with abdominal pain and lower gastrointestinal bleeding. An upper endoscopy was performed which did not reveal a source of bleeding. On colonoscopy, an ileocecal valve (ICV) ulcer was found and biopsies demonstrated necrotizing granulomas with no malignancy, acid-fast bacilli or cytomegalovirus [1]. Initially his symptoms resolved, until six months later when he developed recurrent abdominal pain, diarrhea and increasing weight loss, and underwent repeat colonoscopy. The colonoscopy demonstrated a non-healing 25% circumferential ulcer at the ICV and biopsies again showed inflammation, no acid-fast bacilli or cytomegalovirus (Figure 1). A CT scan was performed demonstrating marked thickening with adjacent mesenteric inflammation and edematous changes of terminal ileum, cecum, appendix and proximal ascending colon. No other abnormalities were identified in the abdomen or pelvis. A chest x-ray demonstrated no lymphadenopathy or pulmonary lesions.