Renal tuberculosis and iliopsoas abscess: Two case reports

Area of Science:

• Nephrology
• Infectious Diseases
• Radiology

Background:

• Extrapulmonary tuberculosis commonly affects the urinary system.
• Urinary tuberculosis (TB) often exhibits diverse and atypical clinical presentations, leading to potential misdiagnosis.
• Renal TB, a form of urinary TB, requires specific diagnostic considerations.

Purpose of the Study:

• To report two distinct cases of renal tuberculosis with differing clinical manifestations.
• To highlight the diagnostic challenges associated with urinary TB.
• To emphasize the role of computed tomography (CT) in diagnosing renal TB.

Main Methods:

• Case report of two patients diagnosed with renal TB.
• Clinical presentation, diagnostic tests (Purified Protein Derivative (PPD), TB antibody tests, acid-fast bacilli in urine), and computed tomography (CT) findings were analyzed.
• Treatment response to anti-tuberculosis drugs was evaluated.

Main Results:

• Case 1: Female patient with loin pain and fever, negative PPD/antibody tests, CT showing renal lesion and iliopsoas abscess, successfully treated with anti-TB drugs.
• Case 2: Male patient with intermittent gross hematuria, positive urine tests for acid-fast bacilli/TB antibodies, CT revealing renal lesion with pelvicaliceal/ureteral dilation, resolved with anti-TB drugs.
• Both cases demonstrated the effectiveness of anti-TB treatment, confirming the diagnosis.

Conclusions:

• Urinary TB diagnosis can be challenging due to atypical presentations.
• Suspicion of TB is warranted in patients with unexplained fever or gross hematuria unresponsive to antibiotics.
• Computed tomography (CT) is an essential imaging modality for investigating suspected urinary tuberculosis.