1. Case study 35 Year old male

2. Background HIV Positive – Stavudine/Lamivudine/Lopinavir Ritonavir combination Renal Failure for 2 years Receive a transplant from HIV positive deceased donor Donor and recipient CMV +

3. Post transplant Thymoglobuline for 5 days MMF/Tacro/Prednisone Continue ARV’s Start Valgancyclovir and Isoniazid prophylactic therapy

4. Start Meropenem

6. Differential diagnosis Fungal infection but no cultures Viral infection TB Drug fever Culture negative endocarditis Granulomatous Hepatitis (Hep serology negative negative but AP going up)

7. Pancytopaenia: Bone marrow biopsy and lumbar puncture Microscopy Findings: Granulomas Culture Findings: M. Tuberculosis (Multidrug resistance confirmed later on) Initally treated with Rifampicin, Isoniazid and Pirazinamid Had to change to: – Ofloxacillin – then Ofloxallin out of stock- started on Moxifloxacin 400mg alternate days – Ethambutol1200mgmon/wed/fri – Ethionamide250mgdaily – Terizidone250mgT.D.S Treated for 2 years

8. Renal biopsy after 2 years

9. Renal Biopsy after 2 years