A Rare Case of Disseminated Tuberculosis and Hematological Malignancy in a Heart Transplant Recipient |
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| Affiliation: | 1. Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA;2. Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA;3. Division of Gastrointestinal, Liver, and Pancreas Pathology, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA;1. Wayne State University School of Medicine, Detroit, Michigan;2. Kidney and Pancreas Transplant Program, Henry Ford Transplant Institute, Detroit, Michigan;1. Study Group of Laser and Health Institute. São Paulo, SP, Brazil;2. Graduate Program in Implantology, University of Santo Amaro, School of Dentistry. São Paulo, SP, Brazil;3. Graduate Dentistry Program, Ibirapuera University. São Paulo, SP, Brazil |
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| Abstract: | A 77-year-old man who underwent a heart transplant 7 years ago presented with multiple bloody bowel movements. Endoscopic and histologic evaluation revealed chronic active ileitis, granulomatous inflammation, multinucleated giant cells, and a rare, equivocal acid-fast bacterium in the terminal ileum. Positive sputum cultures for Mycobacterium tuberculosis and acid-fast bacilli established a diagnosis of intestinal tuberculosis, and RIPE (rifabutin, isoniazid, pyrazinamide, ethambutol) therapy was initiated. Elevated IgG levels on quantitative immunoglobulin testing and a bone marrow biopsy specimen of ≥60% plasma cells confirmed the diagnosis of multiple myeloma that later transformed into its aggressive form, plasma cell leukemia. Induction chemotherapy was initiated; however, the patient experienced retroperitoneal bleeding and pancytopenias, limiting the continuation of chemotherapy, and as a result, the patient was transitioned to palliative care. |
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