WCN25-1261 Journey of stowaway passenger: Decoding hemolytic anemia in a renal transplant recipient

antibiotics.The blood and pus cultures again yielded no growth.Whilst undergoing treatment, he developed dyspnea and orthopnea and a 2D echocardiogram revealed a circumferential pericardial effusion with a normal left ventricular ejection fraction.A therapeutic and diagnostic pericardiocentesis was performed.The fluid was negative for AAFBs and gen xpert and cultured did not yield any growth.A connective tissue disease screen and TB gold quantiferon test were asked for which were negative.He had a CT scan chest and abdomen which were also normal.A urine lipoarabinomannan test was requested for which was positive.Results: The patient was started on anti-TB medications (Rifafor) and pyridoxine with close monitoring of the tacrolimus levels.His symptoms resolved and he was subsequently discharged.He completed six months of treatment and his inflammatory markers remained normal with a stable graft function.He presented one year later with right scrotal swelling and pain.Investigations revealed elevated inflammatory markers and epididymoorchitis with a hydrocele.He was started on intravenous antibiotics and supportive care but had persistent pain and swelling.After a multidisciplinary team meeting, a decision was made to take the patient to theatre.Intraoperatively, the right testes revealed collections of pus and areas of ischemia and necrosis and a decision was made to perform a right orchidectomy.Histological examination revealed necrotizing granulomatous inflammation with positive Ziehl-Nielson staining for AAFBs.He was re-initiated on anti-TB medications and pyridoxine and completed one year of treatment.He has remained symptom free with a stable graft function.Conclusions: This case highlights the complexity of diagnosing tuberculosis in transplant recipients especially extra-pulmonary TB.The clinician has to have a high index of suspicion of TB in transplant recipients as they normally present with atypical symptoms and signs.The sensitivity of the interferon gamma release assay (IGRA) and tuberculin skin tests are much lower than in the non-transplant population.Managing transplant patients with TB is also challenging due to the drug to drug interactions which can lead to graft loss.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.