Renal Tuberculosis: The Masquerader
Tuberculosis (TB) remains a worldwide scourge and the most common cause of mortality from infectious disease. Around 95% of cases occur in developing country. Renal TB is a rare cases that complicates 3-4% of pulmonary TB patients and commonly overlooked in clinical practice due to its symptoms may...
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Interna Publishing
2020-02-01
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| Series: | Acta Medica Indonesiana |
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| Online Access: | https://www.actamedindones.org/index.php/ijim/article/view/826 |
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| author | Rudi Supriyadi Guntur Darmawan Emmy Hermiyanti Pranggono |
| author_facet | Rudi Supriyadi Guntur Darmawan Emmy Hermiyanti Pranggono |
| author_sort | Rudi Supriyadi |
| collection | DOAJ |
| description | Tuberculosis (TB) remains a worldwide scourge and the most common cause of mortality from infectious disease. Around 95% of cases occur in developing country. Renal TB is a rare cases that complicates 3-4% of pulmonary TB patients and commonly overlooked in clinical practice due to its symptoms may mimic other diseases.
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. |
| format | Article |
| id | doaj-art-69b01ccc83e34266ac088ebecdf7d436 |
| institution | Kabale University |
| issn | 0125-9326 2338-2732 |
| language | English |
| publishDate | 2020-02-01 |
| publisher | Interna Publishing |
| record_format | Article |
| series | Acta Medica Indonesiana |
| spelling | doaj-art-69b01ccc83e34266ac088ebecdf7d4362025-08-20T03:51:53ZengInterna PublishingActa Medica Indonesiana0125-93262338-27322020-02-01514Renal Tuberculosis: The MasqueraderRudi Supriyadi0Guntur Darmawan1Emmy Hermiyanti Pranggono2Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran Hasan Sadikin General Hospital, Bandung, IndonesiaDepartment of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran Hasan Sadikin General Hospital, Bandung, Indonesia. Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, IndonesiaDivision of Respiratory and Critical Illness, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran Hasan Sadikin General Hospital, Bandung, IndonesiaTuberculosis (TB) remains a worldwide scourge and the most common cause of mortality from infectious disease. Around 95% of cases occur in developing country. Renal TB is a rare cases that complicates 3-4% of pulmonary TB patients and commonly overlooked in clinical practice due to its symptoms may mimic other diseases. 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.https://www.actamedindones.org/index.php/ijim/article/view/826renaltuberculosispulmonary TB |
| spellingShingle | Rudi Supriyadi Guntur Darmawan Emmy Hermiyanti Pranggono Renal Tuberculosis: The Masquerader Acta Medica Indonesiana renal tuberculosis pulmonary TB |
| title | Renal Tuberculosis: The Masquerader |
| title_full | Renal Tuberculosis: The Masquerader |
| title_fullStr | Renal Tuberculosis: The Masquerader |
| title_full_unstemmed | Renal Tuberculosis: The Masquerader |
| title_short | Renal Tuberculosis: The Masquerader |
| title_sort | renal tuberculosis the masquerader |
| topic | renal tuberculosis pulmonary TB |
| url | https://www.actamedindones.org/index.php/ijim/article/view/826 |
| work_keys_str_mv | AT rudisupriyadi renaltuberculosisthemasquerader AT gunturdarmawan renaltuberculosisthemasquerader AT emmyhermiyantipranggono renaltuberculosisthemasquerader |