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已发表论文
肾移植后耐药结核感染的诊断和治疗挑战：一例罕见病例报告
Authors Song C, Zhao CY, Huang XW , Mo CJ, Qiang HB, Lin XS, Huang ZT, Xie ZH, Zhu QD
Received 31 December 2025
Accepted for publication 9 February 2026
Published 13 February 2026 Volume 2026:19 590648
DOI https://doi.org/10.2147/IDR.S590648
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Hazrat Bilal
Chang Song,1,2,* Chun-Yan Zhao,1,2,* Xue-Wen Huang,1,2,* Chang-Jiang Mo,2 Hang-Biao Qiang,1 Xiao-Shi Lin,2 Zhen-Tao Huang,2 Zhou-Hua Xie,1 Qing-Dong Zhu1
1Department of Tuberculosis, The Fourth People’s Hospital of Nanning, Nanning, Guangxi, 530023, People’s Republic of China; 2Clinical Medical School, Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Qing-Dong Zhu, Department of Tuberculosis, The Fourth People’s Hospital of Nanning, Nanning, Guangxi, 530023, People’s Republic of China, Email zhuqingdong2003@163.com Zhou-Hua Xie, Department of Tuberculosis, The Fourth People’s Hospital of Nanning, Nanning, Guangxi, 530023, People’s Republic of China, Email 1491348066@qq.com
Background: Kidney transplant recipients are at high risk for tuberculosis (TB), particularly drug-resistant forms, due to prolonged immunosuppressive therapy. The diagnosis and treatment of TB in this population pose unique challenges, including infection control, graft protection, and drug interactions.
Case Presentation: We report the case of a 28-year-old male kidney transplant recipient was diagnosed with pulmonary TB four months post-transplantation. The patient self-discontinued initial anti-TB therapy after one month, leading to relapse nine months later, with confirmed rifampicin resistant. Following three months of treatment with a second-line regimen including linezolid, he developed disseminated skeletal TB, with drug susceptibility testing indicating linezolid resistance. The treatment was adjusted to an all-oral regimen including isoniazid, moxifloxacin, clofazimine, cycloserine, and bedaquiline, resulting in significant clinical and radiological improvement.
Discussion: In the present case, the patient’s non-adherence to the medication regimen resulted in initial treatment failure. Against the backdrop of immunosuppression, rifampicin resistance emerged rapidly. Although the subsequent linezolid-containing regimen was administered for a short duration, it likely triggered ribosomal target mutations—leading to linezolid resistance and hematogenous dissemination to the bone—driven by both drug selection pressure and the history of irregular treatment. Confronted with dual resistance and disseminated disease, the therapeutic strategy pivoted to a bedaquiline-based regimen. This shift highlights the clinical management art of finely balancing treatment efficacy with the risk of rejection through the optimized adjustment of immunosuppressants guided by therapeutic drug monitoring.
Conclusion: The management of drug-resistant tuberculosis in kidney transplant recipients necessitates a flexible and comprehensive strategy. This encompasses early clinical suspicion, the prompt performance of molecular and phenotypic drug susceptibility testing to guide therapeutic decisions, rigorous management of treatment adherence, and the real-time adjustment of therapeutic regimens based on evolving resistance profiles and clinical responses. Multidisciplinary collaboration is essential for balancing anti-tuberculosis efficacy with graft survival. Although novel agents such as bedaquiline offer promising options for salvage therapy, their administration in transplant recipients requires intensified monitoring for drug-drug interactions and adverse events.
Keywords: kidney transplantation, drug-resistant tuberculosis, bedaquiline
1Department of Tuberculosis, The Fourth People’s Hospital of Nanning, Nanning, Guangxi, 530023, People’s Republic of China; 2Clinical Medical School, Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Qing-Dong Zhu, Department of Tuberculosis, The Fourth People’s Hospital of Nanning, Nanning, Guangxi, 530023, People’s Republic of China, Email zhuqingdong2003@163.com Zhou-Hua Xie, Department of Tuberculosis, The Fourth People’s Hospital of Nanning, Nanning, Guangxi, 530023, People’s Republic of China, Email 1491348066@qq.com
Background: Kidney transplant recipients are at high risk for tuberculosis (TB), particularly drug-resistant forms, due to prolonged immunosuppressive therapy. The diagnosis and treatment of TB in this population pose unique challenges, including infection control, graft protection, and drug interactions.
Case Presentation: We report the case of a 28-year-old male kidney transplant recipient was diagnosed with pulmonary TB four months post-transplantation. The patient self-discontinued initial anti-TB therapy after one month, leading to relapse nine months later, with confirmed rifampicin resistant. Following three months of treatment with a second-line regimen including linezolid, he developed disseminated skeletal TB, with drug susceptibility testing indicating linezolid resistance. The treatment was adjusted to an all-oral regimen including isoniazid, moxifloxacin, clofazimine, cycloserine, and bedaquiline, resulting in significant clinical and radiological improvement.
Discussion: In the present case, the patient’s non-adherence to the medication regimen resulted in initial treatment failure. Against the backdrop of immunosuppression, rifampicin resistance emerged rapidly. Although the subsequent linezolid-containing regimen was administered for a short duration, it likely triggered ribosomal target mutations—leading to linezolid resistance and hematogenous dissemination to the bone—driven by both drug selection pressure and the history of irregular treatment. Confronted with dual resistance and disseminated disease, the therapeutic strategy pivoted to a bedaquiline-based regimen. This shift highlights the clinical management art of finely balancing treatment efficacy with the risk of rejection through the optimized adjustment of immunosuppressants guided by therapeutic drug monitoring.
Conclusion: The management of drug-resistant tuberculosis in kidney transplant recipients necessitates a flexible and comprehensive strategy. This encompasses early clinical suspicion, the prompt performance of molecular and phenotypic drug susceptibility testing to guide therapeutic decisions, rigorous management of treatment adherence, and the real-time adjustment of therapeutic regimens based on evolving resistance profiles and clinical responses. Multidisciplinary collaboration is essential for balancing anti-tuberculosis efficacy with graft survival. Although novel agents such as bedaquiline offer promising options for salvage therapy, their administration in transplant recipients requires intensified monitoring for drug-drug interactions and adverse events.
Keywords: kidney transplantation, drug-resistant tuberculosis, bedaquiline