Pulmonary-urogenital tuberculois: a delayed diagnosis

Hussin, Fara Rahidah and Shahril, Nor Shuhaila and Zainulabid, Ummu Afeera and Kori, Najma and Periyasamy, Petrick (2023) Pulmonary-urogenital tuberculois: a delayed diagnosis. American Journal of Tropical Medicine and Hygiene, 109 (4 Supplement). p. 199. ISSN 0002-9637 E-ISSN 1476-1645

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Abstract

Urogenital tuberculosis (TB) is responsible for one-third of cases of extrapulmonary TB and occurs in up to 20% of patients with pulmonary TB. We illustrate a diagnostic challenge in a case of pulmonary-urogenital TB with HIV infection. A 60-year-old woman with HIV infection diagnosed in May 2020 following an initial presentation of Escherichia Coli bacteremia complicated by HIV-related immune thrombocytopenic purpura. Computed tomography (CT)thorax revealed tree in bud in bilateral upper lobes with mild hydronephrosis of the right kidney compared to the left kidney. She underwent bronchoscopy and her TB work-up was negative. She was treated for latent TB with Isoniazid-based regime and commenced on antiretroviral therapy and prednisolone. She presented again in February 2023 following a 3-day history of fever with documented temperatures of 380C but no obvious source of infection. She had thrombocytopenia of 45X109/L but normal white cell count, renal and liver function. Her chest radiograph was normal. She was treated as occult sepsis with intravenous (IV) Ceftriaxone and IV Hydrocortisone with subsequent resolution of fever. She had recurrence of her fever with tenderness at right lumbar region after five days of Ceftriaxone. Her antibiotic was escalated to IV Meropenem. Ultrasound abdomen showed gross right hydronephrosis with pyonephrosis. Contrast-enhanced CT thorax and abdomen revealed multiple tree-in-bud nodules prominent in both upper lobes with multiple lung nodules. There were no cavitating lung lesions and enlarged mediastinal lymphadenopathy. There was right hydronephrosis with dilated pelvic-calyces, stenosed infundibulum and right mid ureteric stricture. She underwent a right nephrostomy with subsequent right ureteral stenting. Direct smear urine for acid fast bacilli was positive and Mycobacterium TB(MTB) GeneXpert was positive with indeterminate Rifampicin resistant, pending urine MTB culture and sensitivity. Treatment with anti-TB medications was commenced, with steroid replacement. In conclusion, Urogenital TB can be missed in view of asymptomatic manifestation of hydronephrosis.

Item Type:	Article (Meeting Abstract)
Uncontrolled Keywords:	Urogenital Tuberculosis; HIV
Subjects:	R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC111 Infectious and Parasitic Diseases
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Internal Medicine Kulliyyah of Medicine
Depositing User:	Asst. Dr. Ummu Afeera Zainulabid
Date Deposited:	27 Feb 2024 10:24
Last Modified:	27 Feb 2024 10:24
URI:	http://irep.iium.edu.my/id/eprint/110979

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