Abstract
To prevent organ rejection, renal transplant (RT) recipients must take immunosuppressive medicines, which make them more susceptible to infections such as tuberculosis (TB). Hepatotoxicity, which can vary from asymptomatic increased liver enzymes to severe liver failure, is the most prevalent side effect of first-line antituberculosis (AT) drugs. Treating TB in RT patients involves unique concerns since AT medications might interact with immunosuppressive medications, potentially reducing efficacy or increasing toxicity. A 65-year-old RT recipient was diagnosed with active pulmonary TB 18 years after renal transplantation. He had drug-induced acute liver failure after initiating AT therapy, but his liver function improved after discontinuing AT medications and receiving supportive care.