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Extracorporeal shock wave lithotripsy complicated with miliary tuberculosis
L E Morano Amado1, L Amador Barciela, A Rodriguez Fernandez
1Department of Internal Medicine, Hospital do Meixoeiro, Vigo, Spain.
The Journal of Urology
|June 1, 1993
Summary
Extracorporeal shock wave lithotripsy (ESWL) can potentially trigger miliary tuberculosis in patients with undiagnosed renal tuberculosis. Ruling out kidney tuberculosis before ESWL is crucial to prevent hematogenous dissemination.
Area of Science:
- Nephrology
- Infectious Diseases
- Pulmonology
Background:
- Extracorporeal shock wave lithotripsy (ESWL) is a common procedure for kidney stone removal.
- Undiagnosed renal tuberculosis may pose a risk for disseminated disease following ESWL.
- This case highlights a potential complication of ESWL in patients with underlying tuberculosis.
Observation:
- A patient developed miliary tuberculosis 50 days post-ESWL for renal and ureteral calculi.
- Initial symptoms included fever, weight loss, night sweats, abnormal liver function, and hypoxemia.
- A normal chest X-ray evolved to show a miliary pattern, confirming disseminated tuberculosis.
Findings:
- Diagnosis of tuberculosis was confirmed by sputum culture and liver biopsy showing caseating epithelioid granulomas.
- The patient's condition improved significantly with antituberculous treatment.
- This suggests a link between ESWL and the reactivation or dissemination of tuberculosis.
Implications:
- Pre-ESWL screening for renal tuberculosis is recommended, especially in endemic areas or high-risk patients.
- Healthcare providers should consider tuberculosis in the differential diagnosis for patients presenting with constitutional symptoms after ESWL.
- This case underscores the importance of thorough pre-procedural evaluation to prevent iatrogenic complications.