Microscopy of the explanted liver demonstrates granulomata without demonstrable microorganisms. Subsequent microscopy of a fine-needle aspiration specimen from the submandibular mass demonstrated acid fast bacilli. The unifying diagnosis therefore, is activation of latent mycobacterium tuberculosis (MTB) infection post LT.Reactivation of MTB infection remains the commonest cause of clinically manifested TB after solid organ transplantation.1 Management of reactivated TB after LT is difficult because anti-TB drugs can be both hepatotoxic and able to interact with immunosuppression. There is no gold standard for diagnosing latent TB. The tuberculin skin test is commonly used in screening but lacks sensitivity, especially in the immunosup-pressed. It also lacks specificity because of cross-reactivity with environmental mycobacteria and BCG.2 Newer interferon-y release assays have been used in LT recipients and work by detecting the proliferative response of peripheral lymphocytes to specific MTB antigens.
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