Mastic Kidney: A Rare Radiological Feature

This case emphasizes the importance of considering tuberculosis (TB) in the differential diagnosis of complex kidney imaging findings. We report a case of a 43-year-old male patient from India who presented with a five-day history of fever and vomiting. Laboratory results revealed metabolic acidosis, anemia, acute kidney injury, and elevated inflammatory markers. A computed tomography urogram demonstrated significant findings: minimal parenchymal remnants in the left kidney replaced by caliectasis, ureteral pyelitis, and retroperitoneal lymphadenopathy, including calcified nodes in the right kidney. The diagnosis of genitourinary TB was made after bronchoalveolar lavage and urine samples confirmed the presence of Mycobacterium tuberculosis. The imaging findings were consistent with "mastic kidney," a rare radiological sign of renal TB, characterized by extensive parenchymal destruction. First-line antituberculous therapy was initiated, leading to clinical improvement. This case highlights the critical role of early diagnosis and the importance of considering TB in patients with multisystem involvement. "Mastic kidney," though rare, remains a key radiological sign of renal TB, underscoring the need for heightened clinical awareness in suspected cases of extrapulmonary TB.