Abstract
A 69-year old woman with end-stage kidney disease due to rapidly progressive glomerulonephritis associated with the anti-GBM antibody started hemodialysis 8 months previously. She received hemodialysis three times a week in the local outpatient hemodialysis center. She continued immunosuppressive therapy with prednisolone and cyclophosphamide even after the initiation of hemodialysis because her anti-GBM titer level was high. Low-grade fever developed without any respiratory symptoms two months prior to her admission. She was admitted to our hospital for further evaluations. Chest CT revealed diffuse small nodular lesions in the bilateral lungs. Pulmonary tuberculosis was suspected and T-spot®. TB, the novel Interferon-Gamma Release Assay (IGRA), was performed the next day. The sputum smear was negative for acid-fast bacillus (AFB) staining. The results of T-spot®. TB were positive 3 days later. AFB staining of gastric juice was positive and the M. tuberculosis complex was identified by polymerase chain reaction (PCR). The skin tuberculin test was negative. Anti-tuberculosis treatment was initiated using isoniazid (INH), rifampicin (RFP), pyrazinamide (PZA), and ethambutol (EB). On the 12 th admission day, she was transferred to another hospital with a tuberculosis ward. T-spot®. TB is an enzyme-linked immunosorbent spot (ELISPOT)-based IGRA that became available in Japan in Nov 2012. T-spot®. TB may be a superior IGRA for the diagnosis of tuberculosis in immunocompromised patients than QuantiFERON-TB Gold. This is the first case report that describes the efficiency of T-spot®. TB in the diagnosis of active tuberculosis in a Japanese hemodialyzed patient.
