A Renal Transplant Patient with Psoas Fluid Collection

Abstract

0196-4399/00 (see frontmatter) © 2009 Elsevier Clinical Microbiology Newsletter 31:23,2009 Case Report A60-year-old female patient who had undergone a live-donor-related, rightrenal transplant 4 months previously was hospitalized with severe right-flank and leg pain of 3 months duration, accompanied by fever. Her immunosuppressive regimen included mycophenolate mofetil, tacrolimus, and prednisone. Computed tomography (CT) imaging demonstrated expansion of the right psoas muscle with central low attenuation (Fig. 1). Aspiration of the psoas abscess was performed for aerobic and anaerobic cultures and a Gram-stained smear (Fig. 2). The Gram-stained smear demonstrated numerous “ghost cells” and grampositive cells with a beaded appearance, suspicious for mycobacteria. On the basis of these findings, additional studies of the aspirate were ordered. An auramine-rhodamine stain verified the presence of many acid-fast bacilli. The Gen-Probe AmplifiedMycobacterium tuberculosis direct assay (Gen-Probe, San Diego, CA) of the specimen was positive, andM. tuberculosis was isolated subsequently from mycobacterial cultures after 3 days of incubation. On follow-up, the patient disclosed that for 3 months she had been experiencing night sweats so severe that she would awaken at night, shower, and change her clothing and bedding. Further workup demonstrated diffuse, bilateral, military, pulmonary nodules on CT imaging. Although mycobacterial cultures and smears of induced sputum specimens were negative, M. tuberculosis complex was detected by the Gen-Probe Amplified direct assay. Para-aortic, paracaval, and right inguinal lymphadenopathy with central low attenuation was also present on imaging. Additionally, 20 years previously, the patient had a positive tuberculin skin test for which she received treatment with a single drug. At that time, the patient’s 1-year-old son was diagnosed with active tuberculosis, for which he underMailing address: Robin Patel, M.D., Division of Clinical Microbiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. Tel.: 507-538-0579. Fax: 507-2844272. E-mail: patel.robin@mayo.edu Case Report