A69-39 Primary Pulmonary Tuberculosis in a Double Lung Transplant Recipient

Abstract Introduction This case describes a new primary pulmonary TB in a Double Lung Transplant Recipient (DLT) and our treatment strategy for this infection. Case Report A 66-year-old female with a past medical history of sarcoidosis on infliximab, ILD, and previously treated MAC infection, underwent DLT and was found to have positive AFB cultures for Mycobacterium tuberculosis three months post lung transplant. Pre transplant, she had two intracavitary mycetoma in the right upper lobe, negative T spot, positive Aspergillus galactomannan, and positive Fungitell. Donor AFB cultures were negative. Transplant infectious disease was consulted, and patient was started on RIPE therapy, with de-escalation to 2-drug therapy after two months, and plan for a total of 9 months of therapy. Her course was complicated by acute renal injury requiring hemodialysis, digital ischemia status-post amputation, tracheostomy for hypercapnic respiratory failure with difficulty weaning ventilation, and chronic wounds. Discussion It is still unclear when the patient got inoculated with TB given the negative pre-transplant status of both donor and recipient. Although less likely, the patient might have had a seroconversion pretransplant which was not detected on pre transplant evaluation and progressed to pulmonary tuberculosis after immunosuppression. Overall, this case highlights the importance of screenings prior to lung transplant for both donors and recipients with close follow-up after transplant. This abstract is funded by: None