CHALLENGES IN PULMONARY TUBERCULOSIS MANAGEMENT IN A LIVER TRANSPLANT RECIPIENT WITH CROHN’S DISEASE: A CASE REPORT

Background: Tuberculosis (TB) poses a substantial risk as an opportunistic infection in individuals who have received solid organ transplants, particularly in those with liver transplants compounded by inflammatory bowel disease. Managing TB in this group is particularly challenging due to possible drug interactions and the heightened risk of liver toxicity. Case study: We present a 35-year-old male liver transplant recipient with Crohn’s disease, who developed pulmonary TB despite prior prophylaxis and immunosuppression. The first anti-TB treatment was modified and dose-reduced due to the patient's immunocompromised status. This regimen failed, with recurrent positive sputum cultures. Upon retreatment with a full-dose triple regimen excluding pyrazinamide, the patient responded well with full recovery and no adverse hepatic or Crohn’s-related events. Conclusion: This case illustrates the challenges of treating TB in liver transplant patients with Crohn’s disease, emphasizing the delicate balance between achieving therapeutic effectiveness and minimizing hepatotoxicity. In carefully selected patients, administering a complete tuberculosis treatment protocol without pyrazinamide can provide a safe and effective therapeutic outcome.