Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach. 1. Introduction Mycobacterium tuberculosis (MT) is a common infectious agent, particularly in developing countries, with a reported incidence of 18.9？cases/100.000 inhabitants/year in general population [1–3]. The prevalence of tuberculosis (TB) in Portugal is high (34 cases per 100.000 inhabitants/year), corresponding to three times the average in Western Europe [4]. In transplanted patients the incidence of this opportunistic agent is even more frequent, with 512 cases/100.000 inhabitants/year and it is often linked to adverse outcomes [1–3]. In transplant recipients, MT infection can be due to primary infection, reactivation of latent TB foci favored by immunosuppression (IS), or, in a lesser extent (4%), it can be transmitted by the allograft [3, 5, 6]. In most cases, the disease involves the lungs. However, unlike general population, in renal transplant (RT) patients, extrapulmonar (occurring in 15%) and disseminated diseases (33–49%) are very frequent [1–3, 7]. In these patients atypical presentation is the rule and it requires a high clinical suspicion for its diagnosis [8]. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring frequent adjustment of maintenance therapy. Delayed diagnosis of TB and drug interactions may contribute to extremely high mortality in RT recipients [7]. The authors report two cases of isolated gastrointestinal (GI) TB in RT recipients that illustrates the difficulty of its diagnosis and do a brief review of the literature on this topic. 2. Case 1 A 53-year-old man with end-stage renal failure (ESRD) of unknown etiology was on hemodialysis (HD) since 1999. He underwent a first RT in 2000, with cyclosporine (CyA), mycophenolate mofetil (MMF), and prednisolone as
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