Genitourinary Tuberculosis Resulting in Hydronephrosis - European Medical Journal

Genitourinary Tuberculosis Resulting in Hydronephrosis

1 Mins
Respiratory
Authors:
**Katie Alsheimer,1 Faraz Siddiqui,1 Jonathan Burgei,1 Julia Lantry1
  • 1. Department of Pulmonary and Critical Care Medicine, Guthrie Clinic Robert Packer Hospital, Sayre, Pennsylvania, USA
*Correspondence to [email protected]
Disclosure:

The authors have declared no conflicts of interest.

Citation:
Respir AMJ. ;2[1]:36-37. https://doi.org/10.33590/respiramj/AIWO1176.
Keywords:
Acid-fast bacilli, bilateral hydronephrosis, epididymo-orchitis granuloma, genitourinary tuberculosis (GUTB), necrotizing granulomatous.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND

Genitourinary tuberculosis (GUTB) results from hematogenous spread of chronic latent pulmonary tuberculosis of 5–40 years.1 The diagnosis is typically delayed, as it can mimic a urinary tract infection.1,2 Only 5–45% of cases of tuberculosis have extrapulmonary manifestation, and of these, only 30–40% involve the urogenital tract.1

CASE PRESENTATION

This is a case of a male in his 60s who was immunocompromised due to rheumatoid arthritis, requiring methotrexate and chronic prednisone. He was diagnosed with GUTB requiring orchiectomy secondary to recurrent epididymo-orchitis. The pathology following his epididymo-orchitis showed necrotizing granulomatous infection with negative cultures. However, urine culture was significant for pyuria and acid-fast bacilli. Cystoscopy was notable for bilateral hydronephrosis associated with significant bladder inflammation and ureteral strictures. He was treated with levofloxacin 750 mg daily for 6 months, rifampin 600 mg daily for 6 months, pyrazinamide 1,500 mg daily for 2 months, ethambutol 1,200 mg daily for 2 months, and pyridoxine 50 mg daily for 6 months as it was resistant to isoniazid (Figure 1).

Figure 1: CT of abdomen shows severe hydronephrosis in the right ureter.

CONCLUSION

Prompt diagnosis of GUTB can prevent the need for invasive procedures and improve the quality of life of patients that have GUTB. Improved awareness of the diagnosis can improve diagnosis time. Patients who require prolonged immunosuppression should be screened not only for tuberculosis, but also monitored and/or receive prophylactic therapy against opportunistic infections.

References
Jha SK, Rathish B, Genitourinary Tuberculosis [Internet] (2023) Treasure Island: StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557558/. Last accessed: 23 April 2024. Muneer A et al. Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019;16(10):573-98. World Health Organization (WHO). WHO consolidated guidelines on tuberculosis: module 2: screening: systematic screening for tuberculosis disease. 2021. Available at: https://www.who.int/publications/i/item/9789240022676. Last accessed: 23 April 2024. World Health Organization (WHO). WHO consolidated guidelines on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. 2021. Available at: https://www.who.int/publications/i/item/9789240029415. Last accessed: 21 April 2024. World Health Organization (WHO). Catalogue of mutations in Mycobacterium tuberculosis complex and their association with drug resistance. 2021. Available at: https://www.who.int/publications/i/item/9789240028173. Last accessed: 21 April 2024. Centers for Disease Control and Prevention (CDC). Tuberculosis (TB). Available at: https://www.cdc.gov/tb/index.html. Last accessed: 23 April 2024.

Rate this content's potential impact on patient outcomes

Average rating / 5. Vote count:

No votes so far! Be the first to rate this content.

Thank you!

Please share some more information on the rating you have given