- Central nervous system tuberculosis can present in heavily immunosuppressed heart transplant recipients and poses significant diagnostic, therapeutic and preventive challenges.
- Diagnosis established by positive molecular test of cerebrospinal fluid; prompt antituberculous therapy produced clinical improvement and initial discharge.
- Poor treatment adherence caused relapse with cerebral vasculitis; restarting therapy and completing 12 months resulted in favourable outcome.
Einstein (Sao Paulo). 2026 Nov 2;24:eRC2463. doi: 10.31744/einstein_journal/2026RC2463. eCollection 2026.
ABSTRACT
A 33-year-old woman who had undergone heart transplantation two years earlier for post-COVID-19 myocarditis was admitted with decompensated heart failure secondary to acute antibody-mediated rejection. During hospitalization, she developed sepsis, cytomegalovirus infection, acute kidney injury, and an incidental pulmonary miliary pattern on chest computed tomography, without microbiological confirmation. After stabilization, approximately six months later, she presented with headache, fever, and focal neurological signs. Meningoencephalitis caused by Mycobacterium tuberculosis was diagnosed based on a positive molecular test of the cerebrospinal fluid, and antituberculous therapy was started, resulting in clinical improvement and discharge. Four months later, she was readmitted with decreased consciousness, and relapse associated with cerebral vasculitis was identified and attributed to poor treatment adherence. Therapy was restarted and continued for 12 months, with a favorable outcome. This case highlights the diagnostic, therapeutic, and preventive challenges of central nervous system tuberculosis in heavily immunosuppressed solid organ transplant recipients.
PMID:42987051 | DOI:10.31744/einstein_journal/2026RC2463
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