Lisa Ramdhanie, DO
Hackensack Meridian Health JFK Johnson Rehabilitation Institute
Edison, NJ
Disclosure information not submitted.
Kelly Cervellione, M.A., MPhil
Clinical Research Director
MediSys Health Network
Richmond Hill, New York, United States
Disclosure information not submitted.
marco kaldas, n/a
Medicine Attending
Jamaica Hospital
Richmond Hill, New York, United States
Disclosure information not submitted.
Title: Extrapulmonary Presentation of Tb: Atypical Urogential Disease Presentation of a Common Disease
Introduction: Disseminated TB is rare, accounting for < 2% of TB cases in immunocompetent individuals. Initial symptoms of TB typically include cough, fever, and weight loss. When there are extra-pulmonary manifestations, symptoms can depend on the affected sites. However, when there are no pulmonary manifestations, TB is not often considered in the differential, especially in an immunocompetent individual. As in our patients’ case, delayed diagnosis led to critical illness.
Description: A 48 -year-old male who emigrated from Guyana presented in 9/2020 with fulminant respiratory distress and renal failure requiring emergent intubation and dialysis. Despite extreme presentation, his clinical course began with a relatively simple complaint of hematuria in 6/2016. He was discharged home with antibiotics for presumed UTI. Over the next year, he was evaluated numerous times for hematuria and dysuria that did not resolve with antibiotics. In 12/2017, CT revealed bilateral hydronephrosis, left hydroureter and bladder thickening. He was discharged on antibiotics with outpatient urology. He returned to the ER in 2/2018 with unresolved symptoms, found to have epididymitis. He was given antibiotics and advised outpatient urology follow up. 9/2020, he was hospitalized for worsening dysuria and hematuria with associated weight loss and fevers. HIV was negative. Repeat abdominal CT showed abnormal wall thickening of the left ureter and renal collecting system associated with para-aortic lymphadenopathy. White fluffy matter was noted in the bladder during cystoscopy. CT chest had calcified pulmonary nodules. Cystoscopy sample and sputum were positive for mycobacterium TB. Patient left AMA with TB medications. He returned 8 days in respiratory distress requiring emergent intubation and dialysis. He was started on RIPE therapy. He improved and was extubated. After 32 days of hospitalization, 3 AFBs were negative and he was discharged but with dialysis dependent.
Discussion: TB is most often is a pulmonary diagnosis detected on chest imaging. In this case the primary complaint was hematuria with no respiratory symptoms suggested of lung disease. Though it is more common in immunocompromised patients, renal TB may be considered in immunocompetent patients coming from endemic areas with symptoms that are non-responsive to antibiotics.