Mucocutaneous TB after liver transplantation: a challenging
Published in BMC Infectious Diseases, the authors present a rare case of cutaneous tuberculosis after orthotopic liver transplantation (OLT )without the involvement of any other organs.

A 59-year-old male reported with a ulcerative lesion of the left lower lip. He had already received antibiotic treatment with amoxicillin/clavulanate plus antiviral acyclovir for 10 days in other outpatient facilities without any clinical improvement. His clinical history was remarkable for hepatitis B and Genotype 3 hepatitis C co-infection, which led to OLT due to HCC, and several years spent in foreign countries.

Neither before nor after OLT, latent TB infection (LTBI) therapy was administered. Patient received OLT and 14 months post-transplant presented with a lower lip lesion. At the time of presentation patient was on the following medications: entecavir1000 mg daily for chronic HBV with lamivudine resistance, tacrolimus 3 mg daily and everolimus 1 mg twice a day for immunosuppression.

A punch biopsy of the lower lip lesion was performed and submitted for extended microbiology and histological examination. The histological examination suggested chronic granulomatous inflammation.

Real time PCR was positive for MTB by high grading, implying a high bacterial load in the analysed specimen. A total body CT scan was performed to rule out presence of granuloma or signs of pulmonary or other extra-pulmonary site involvement.

A treatment with rifabutin (450 mg/daily), isoniazid (300 mg/daily), ethambutol (1200 mg/daily), pyrazinamide (1500 mg/daily) and daily supplementation of B6 vitamin was started for the intensive phase of 2 months. The therapeutic regimen was then simplified to rifabutin (300 mg/daily) plus isoniazid (300 mg/daily) for the following 4 months.

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