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Urinary tuberculosis masquerading as recurrent urinary tract infection and renal failure: a case report
泌尿道結核偽裝成反覆泌尿道感染和腎衰竭：個案報告
摘要
In Taiwan, urogenital tuberculosis (TB) is the third most common form extrapulmonary TB. Because urogenital TB usually is non-specific symptoms, disease progression to chronic renal failure could be delay diagnosed by clinician doctor unawareness. We report a case of recurrent urinary tract infection complicated with acute on chronic renal failure and bilateral hydronephrosis. The abdomen computed tomography found bilateral hydronephrosis, hydroureter and contract bladder. Chest computed tomography showed diffuse miliary nodules in the both interlobular lower lung field, highly suspected miliary TB. Bilateral percutaneous nephrostomy was placed to avoid renal function deterioration. Urine and sputum TB culture reported mycobacterium tuberculosis. This patient was finally diagnosed with miliary and urinary TB. Four combined anti-TB regimen (isoniazid, rifampin, pyrazinamide, and ethambutol) were scheduled for 6-9 months. Continue PCN drainage was maintained to protect renal function impairment until complete anti-TB therapy course and remission of hydronephrosis. Our case suggests that it is necessary to keep in mind the possibility of urinary TB could be delay diagnosed in patients with recurrent urinary tract infection.
並列摘要
在台灣，泌尿道結核是第三常見的肺外結核疾病。因為泌尿道結核經常是沒有任何症狀，所以容易造成臨床醫師沒有注意而病情惡化進展到慢性腎臟病。我們報告一位個案臨床表現為反覆泌尿道感染、慢性腎衰竭合併急性惡化和腎水腫。腹部電腦斷層報告為雙側腎水腫、輸尿管積水和膀胱壁收縮狹窄。胸部電腦斷層報告為瀰漫性粟粒性結節在雙小葉間下肺野，疑似粟粒性結核病。我們放置雙側經皮腎造口術來避免腎臟功能嚴重惡化。結核尿液和結核痰液培養報告都為結核分枝桿菌。最終病人診斷為泌尿道結核和粟粒性結核病。四合一的抗結核藥物預計使用6到9個來來根治結核病。雖然病人的腎功能無法完全恢復到之前的水準，但也沒再惡化到需要透析治療的情況。我們的個案報告指出在反覆性泌尿道感染的病人，臨床醫師需要非常注意泌尿道結核的可能性。