Renal Tuberculosis: The Masquerader
A-39-year-old man was admitted to our institution due to flank pain. He had history of low grade fever and oligouria since 5 months prior. He had no complaint of cough, dyspnea, or night sweat. He was a non smoker and had no past medical history of tuberculosis. Previous 4 months abdominal ultrasound showed left pelvocaliectasis and ureteral dilatation with suspicion of left ureteral stenosis. Ureterolithiasis could not be excluded. No prostate enlargement or vesicolithiasis was seen. Intravenous pyelography (IVP) examination demonstrated similar finding. Initial laboratory blood examination showed anemia (10.7 g/dl), leukocytosis (14,080/ul), increased in serum creatinin (4.2 mg/dl), ureum (227 mg/dl), and calcium (6.78 mg/dl). Serology examinations were negative for HIV, HBsAg, anti HCV and blood culture had no growth. Urinary examination revealed severe leucocyturia, hematuria, and negative for bacteria, nitrite and cast. Urine culture was positive for Candida glabrata. Pulmonary X-ray suggested right pleural fibrotic. He was initially diagnosed as multiple myeloma with fungal infection. Nevertheless, additional peripheral blood smear showed neither rouleaux formation nor blast. He underwent percutaneous nephrostomy and got micafungin intravenously. Instead of improving, the patient deteriorated and transferred to intensive room. We then explored the possibility of TB infection. Further examination revealed positive for Mycobacterium tuberculosis in urinary polymerase chain reaction (PCR) test. Tracheal sputum examination was positive for acid fast bacilli staining. There was low level of serum vitamin D2 (5.8 ng/ml). He got TB treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol. Unfortunately, the patient eventually succumbed.
de Oliveira JL, da Silva Junior GB, Daher EDF. Tuberculosis-associated chronic kidney disease. Am J Trop Med Hygiene. 2011;84(6):843-4.
Kumar S, Shankaregowda SA, Choudhary GR, Singla K. Rare presentation of genitourinary tuberculosis masquerading as renal cell carcinoma: A histopathological surprise. J Clin Imag Sci. 2014;4.
Lima NA, Vasconcelos CC, Filgueira PHO, et al. Review of genitourinary tuberculosis with focus on end-stage renal disease. Revista do Instituto de Medicina Tropical de São Paulo. 2012;54(1):57-60.
Abbara A, Davidson RN. Etiology and management of genitourinary tuberculosis. Nature Rev Urol. 2011;8(12):678.
Daher EDF, da Silva Junior GB, Barros EJG. Renal tuberculosis in the modern era. Am J Trop Med Hygiene. 2013;88(1):54-64.
Ramana K. Pulmonary tuberculosis disseminating and presenting as bilateral hydronephrosis and renal abscess: a potential threat in the era of multi-drug resistant tuberculosis MDR-TB. Am J Infect Dis Microbiol. 2014;2:48-50.
Rui X, Li XD, Cai S, Chen G, Cai B. Ultrasonographic diagnosis and typing of renal tuberculosis. Int J Urol. 2008;15(2):135-9.
Huang S-J, Wang X-H, Liu Z-D, et al. Vitamin D deficiency and the risk of tuberculosis: a meta-analysis. Drug design, development and therapy. 2017;11:91.
Iftikhar R, Kamran SM, Qadir A, Haider E, Bin Usman H. Vitamin D deficiency in patients with tuberculosis. J Coll Physicians Surg Pak. 2013;23(10):780-3.
Kearns MD, Tangpricha V. The role of vitamin D in tuberculosis. J Clin Transl Endocrinol. 2014;1(4):167-9.
Araujo CA, Araujo NA, Daher EF, et al. Resolution of hypercalcemia and acute kidney injury after treatment for pulmonary tuberculosis without the use of corticosteroids. Am J Trop Med Hygiene. 2013;88(3):592-5.
Peces R, de la Torre M, Alcázar R, Tejada F, Gago E. Genitourinary tuberculosis as the cause of unexplained hypercalcaemia in a patient with pre-end-stage renal failure. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association-European Renal Association. 1998;13(2):488-90.
Tebben PJ, Singh RJ, Kumar R. Vitamin D-mediated hypercalcemia: mechanisms, diagnosis, and treatment. Endocrine Rev. 2016;37(5):521-47.
Xia J, Shi L, Zhao L, Xu F. Impact of vitamin D supplementation on the outcome of tuberculosis treatment: a systematic review and meta-analysis of randomized controlled trials. 2014.
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