Drug-resistant Monoarticular Wrist Joint Tuberculosis in Renal Transplant Recipient with Literature Review

Abstract

Extrapulmonary tuberculosis (TB) is more frequently encountered among renal transplant recipients than in normal population. As per the published literature, this is the first case of a renal transplant recipient with multidrug-resistant (MDR) joint TB from our country. A patient in the seventh decade presented with swelling of the left wrist for 1 month. He underwent positron emission tomography–computed tomography-guided joint aspiration in which GeneXpert came out positive for Mycobacterium tuberculosis and rifampicin resistance was detected. The patient had twice received antituberculous therapy in the past for pulmonary and joint TB. He was started on five-drug MDR-TB drug combination, including bedaquiline, and he responded well with subsidence of joint swelling. Treatment of MDR-TB in a renal transplant recipient is a difficult task as the MDR-TB drugs are potentially toxic and some have drug interactions with immunosuppressive agents that can lead to difficulties in maintaining therapeutic trough levels.