AB 74. Recurrence of pulmonary tuberculosis in a patient with undiagnosed kidney tuberculosis
Background: Tuberculosis of the urinar y system commonly complicates post-primary tuberculosis. In patients with active kidney tuberculosis, coincident lung disease often prevails in clinical picture, thus the diagnosis of urinary disease often escapes. Presentation of an interesting case of lung and kidney tuberculosis.
Patients and Methods: A 32 year-old female was referred to our clinic for investigation of possible kidney and lung tuberculosis. The patient reported two years of dysuric symptoms, with recurrent episodes of painless macroscopic haematuria. From recent history the patient reported two hospitalizations over a month due to fever and malaise, with laboratory findings of normochromic normocytic anemia, high ESR and microscopic hematuria and aseptic pyouria with normal renal function. Chest CT revealed scattered infiltrates in the middle and upper lung fields, ground-glass opacities and tree-in-bud pattern. CT scan of the abdomen showed hydronephrosis and hypodense areas in the left and right kidney, findings we also confirmed by kidney ultrasonography. Patient presented in our clinic with low grade fever and satisfactory respiratory function, while findings from the physical examination of the chest were insignificant. Mantoux test showed an infiltration of 15 mm. Direct sputum examination by Ziehl-Nielsen staining and PCR for M.Tuberculosis were negative. Ultimately, the diagnosis of lung disease and urinary tuberculosis were confirmed by positive Gen-probe results of gastric fluid and urine specimens and subsequent positive cultures. Prompt initiation of antituberculous therapy was followed by the patient’s marked clinical improvement within a few days and subsequent negative urine examination by Ziehl-Nielsen staining.
Results: Due to suspected hematogenous spread, the patient underwent fundoscopy and CT scan of the brain which revealed no pathological findings. To address hydronephrosis, a Pig-tail catheter was inserted in the left kidney. The patient received anti-tuberculous therapy for a year. During the follow-up period she remained in excellent general condition, with negative sputum and urine cultures and improvement of the imaging findings in the lungs and kidneys.
Conclusions: The initial presentation of urinary tract tuberculosis may be vague and the false interpretation of symptoms can result in great harm to the patient.
