Efficiency of the Interferon-Gamma Release Assay T-spot<SUP>®</SUP>.<I>TB</I> on the diagnosis of active tuberculosis in a patient receiving maintenance hemodialysis

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  • Koda Ryo
    Department of Nephrology, Dokkyo Medical University Koshigaya Hospital
  • Yoshino Atsunori
    Department of Nephrology, Dokkyo Medical University Koshigaya Hospital
  • Imanishi Yuji
    Department of Nephrology, Dokkyo Medical University Koshigaya Hospital
  • Kawamoto Shinya
    Department of Nephrology, Dokkyo Medical University Koshigaya Hospital
  • Takeda Tetsuro
    Department of Nephrology, Dokkyo Medical University Koshigaya Hospital
  • Mizuguchi Mari
    Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
  • Fueki Naoto
    Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
  • Sagara Hironori
    Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital

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Other Title
  • インターフェロンγ遊離試験T-スポット<SUP>®</SUP>.<I>TB</I>が結核症の診断に有用であった透析患者の1例
  • 症例報告 インターフェロンγ遊離試験T-スポット.TBが結核症の診断に有用であった透析患者の1例
  • ショウレイ ホウコク インターフェロンgユウリ シケン T-スポット.TB ガ ケッカクショウ ノ シンダン ニ ユウヨウ デ アッタ トウセキ カンジャ ノ 1レイ
  • Efficiency of the Interferon-Gamma Release Assay T-spot^|^reg;.TB on the diagnosis of active tuberculosis in a patient receiving maintenance hemodialysis

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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.

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