Tuberculosis urogenital en un paciente con falla renal, estado del arte / Urogenital tuberculosis in a patient with kidney failure, state of the art

RESUMEN La tuberculosis es una enfermedad infecciosa y frecuente en países en vía de desarrollo. Esta puede causar una amplia variedad de complicaciones y presentaciones atípicas con alta morbimortalidad. De la forma genitourinaria se sospechada muy poco, razón por la cual su diagnóstico se hace, usualmente, de forma tardía o no se realiza. Esto conlleva a consecuencias muy graves en los pacientes, por ejemplo, la enfermedad renal crónica terminal. A continuación, se presenta un reporte de caso de una paciente con la anterior enfermedad, secundaria a una tuberculosis renal bilateral diagnosticada tardíamente y se realiza una revisión de la literatura sobre este tema.

SUMMARY Tuberculosis is a common infectious disease in developing countries, which can cause a variety of complications and atypical manifestations with high morbidity and mortality. The urogenital form is rarely suspected, resulting in delayed diagnosis or even no diagnosis, which can have serious consequences for the patients, such as chronic end-stage renal disease. We report on a patient with chronic end-stage renal failure caused by a delayed diagnosis of bilateral renal tuberculosis and a literature review on this topic.

Urogenital tuberculosis in a patient with end-stage renal disease.

Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression.

Urogenital tuberculosis in a patient with end-stage renal disease

Abstract Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression.

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

Vulvar Tuberculosis-A Rare Manifestation of the Disease.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas de morte no mundo. Embora afete mais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis por meios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

Vulvar tuberculosis-A rare manifestation of the disease / Tuberculose vulvar - Uma manifestação rara da doença

Abstract Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

Resumo A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas demorte nomundo. Embora afetemais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis pormeios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar / Hydrocele as initial manifestation of genitourinary and miliary tuberculosis / Hidrocele como manifestação inicial da tuberculose geniturinária e miliar

Introducción. La tuberculosis es una enfermedad infectocontagiosa que puede afectar cualquier órgano del cuerpo, incluyendo el sistema genitourinario, representando el 33.7-45.5 % de las tuberculosis extrapulmonares. El objetivo de este trabajo es reportar el caso de un paciente con hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar, enfermedad que no se sospechaba. Presentación del caso. Paciente masculino previamente sano, que consulta a urgencias por orquialgia e hidrocele bilateral, con secreción purulenta por escroto, requiriendo manejo antibiótico intravenoso e hidrocelectomía derecha, con hallazgos intraoperatorios de engrosamiento del epidídimo derecho, y drenaje de material caseoso y purulento. Se realizó epididimectomía ipsilateral, se solicitaron pruebas de detección de bacilos tuberculosos en espécimen y derivado proteico purificado, que fueron positivas. En el postoperatorio presentó sintomatología respiratoria; paraclínicos evidenciaron compromiso pulmonar, pleural y de la vía urinaria por bacilos tuberculosos. Se inicia manejo antituberculoso con evolución satisfactoria. Discusión. El genitourinario es considerado el segundo sistema con mayor afectación de tuberculosis extrapulmonar. El órgano más afectado es el riñón (en un 80 % con respecto a los demás) y el órgano genital es el epidídimo (22 - 55 %). Debe sospecharse en pacientes con síntomas urinarios crónicos sin causa aparente. Se asocia a una alta tasa de morbimortalidad por infertilidad y falla renal. Conclusiones. A pesar de su sintomatología inespecífica y de tratarse de una entidad poco sospechada, la tuberculosis genitourinaria debe descartarse al existir tuberculosis pulmonar. Su diagnóstico y tratamiento oportuno serán de gran importancia para evitar complicaciones secundarias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introduction. Tuberculosis is an infectious disease that can affect any organ in the body, including the genitourinary system, which accounts for 33.7 - 45.5 % of non-pulmonary tuberculosis cases. The purpose of this paper is to report a case of hydrocele as initial manifestation of genitourinary and miliary tuberculosis, which was an unsuspected disease. Case Presentation. Previously healthy male patient is admitted to emergencies due to orchialgia and bilateral hydrocele, with purulent secretion from the scrotum. Was managed with intravenous antibiotic and right hydrocelectomy. Intraoperative findings of thickening of right epididymis and drainage of caseous and purulent material. Ipsilateral epididymectomy was performed; testing for detection of tubercle bacillus in specimen and purified protein derivative was requested, and was found positive. In the postoperative period, respiratory symptoms arose; paraclinical tests found compromised lungs, pleura and urinary tract by tubercle bacillus. Antituberculous treatment was initiated with satisfactory evolution. Discussion. The genitourinary system is the second-most affected system by nonpulmonary tuberculosis. The most affected organ is the kidney (by 80 % compared to the others) and the most affected genital organ is the epididymis (22 - 55 %). It should be suspected in patients with chronic urinary symptoms with no apparent cause. It is associated with a high rate of morbidity and mortality due to infertility and kidney failure. Conclusions. Despite the non-specific symptoms and because it is not normally a suspected entity, genitourinary tuberculosis should be ruled out when pulmonary tuberculosis exists. Timely diagnosis and treatment are very important in order to prevent secondary complications. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introdução. A tuberculose é uma doença infecciosa que pode afetar qualquer órgão do corpo, incluindo o sistema geniturinário, representando 33.7 a 45.5 % da tuberculose extrapulmonar. O objetivo deste trabalho é relatar o caso de um paciente com hidrocele como uma manifestação inicial de tuberculose geniturinária e miliar, uma doença que não se suspeitava. Apresentação do caso. Paciente do sexo masculino previamente saudável, que consultou a emergência para orquialgia e hidrocele bilateral, com secreção purulenta do escroto, necessitando de tratamento antibiótico endovenoso e hidrocelectomia direita, com achados intraoperatórios de espessamento do epidídimo direito e drenagem de material purulento e caseoso. Foi realizada uma epididimectomia ipsilateral e foram solicitados exames de bacilos tuberculosos em espécime e derivado proteico purificado, que foram positivos. No pós-operatório, apresentou sintomas respiratórios; testes para-clínicos mostraram comprometimento pulmonar, pleural e do trato urinário devido a bacilos da tuberculose. Começa-se o tratamento antituberculose com evolução satisfatória. Discussão. O sistema geniturinário é considerado o segundo com maior comprometimento da tuberculose extrapulmonar. O órgão mais afetado é o rim (80 % em relação aos demais) e o órgão genital é o epidídimo (22 a 55 %). Deve-se suspeitar em pacientes com sintomas urinários crônicos sem causa aparente. Está associada a uma alta taxa de morbimortalidade devido à infertilidade e insuficiência renal. Conclusões. Apesar de sua sintomatologia inespecífica e de ser uma entidade pouco suspeitada, a tuberculose geniturinária deve ser descartada quando existir tuberculose pulmonar. Seu diagnóstico e tratamento oportuno serão de grande importância para evitar complicações secundárias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Tuberculosis miliar y orquiepididimitis tuberculosa en un paciente inmunocompetente / Miliary Tuberculosis and Tuberculosis Orchidepidimitis in an Immunocompetent Patient

La tuberculosis genitourinaria es la segunda forma de presentación más común de tuberculosis extrapulmonar luego del compromiso ganglionar, la epididimitis tuberculosa afecta preferentemente a pacientes con edades comprendidas entre los 30 y 50 años, y al menos un 70% tienen historia previa de tuberculosis pulmonar, la infección tuberculosa del escroto es rara y ocurre en aproximadamente el 7% de los pacientes con tuberculosis por extensión directa desde el epidídimo, planteando problemas de diagnóstico diferencial con procesos más agresivos como las neoplasias testiculares. Reportamos el caso de un hombre de 23 años con masa testicular que emulaba ser de origen neoplásico, llevado a orquidectomía unilateral. La patología describe necrosis y granulomas de caseificación conclusivo para orquiepididimitis tuberculosa, paciente inmunocompetente sin antecedente previo de tuberculosis.

Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis after lymph node involvement; tuberculous epididymitis preferentially affects patients between the ages of 30 and 50 years, and at least 70% have a previous history of pulmonary tuberculosis, tuberculous infection scrotum is rare and occurs in approximately 7% of patients with tuberculosis by direct extension from the epididymis, posing problems of differential diagnosis with more aggressive processes such as testicular tumors. We report the case of a 23-year-old man with a testicular mass that emulated being of neoplastic origin, taken to unilateral orchidectomy. The pathology describes necrosis and caseification granulomas, conclusive for tuberculous orchiepididymitis, an immunocompetent patient with no previous history of tuberculosis

Manifestaciones tomográficas extrapulmonares de TBCy algunas de sus complicaciones asociadas / Extrapulmonary TB Tomography and some Associated Complications

La Tuberculosis (TBC) es una patología infecto-contagiosa de alta morbimortalidad en Chile y en el mundo, siendo la segunda causa de muerte por cuestión infecciosa y es considerada una patología de alta relevancia a nivel de salud pública. Es causada por una bacteria de alta virulencia y contagio llamada mycobacterium tuberculosis. En la actualidad contamos con protocolos de detección y tratamiento muy eficaces, que la convierten en una enfermedad prevenible y curable. El diagnóstico se realiza con estudios bacteriológicos específicos frente a una sospecha clínica-epidemiológica sugerente. Sin embargo, el uso de imágenes forma parte casi obligatoria de su estudio y control. Debido a que el órgano diana de la TBC es el pulmón, es habitual utilizar como apoyo diagnóstico una radiografía de tórax, la cual es útil, en caso de TBC pulmonar, al presentar hallazgos característicos y orientadores para su diagnóstico. Es importante destacar que el mycobacterium tuberculosis tiene alto potencial de diseminación por contigüidad, vía linfática y/o hematógena, siendo esa última vía la causante de la mayoría de las TBC extrapulmonares, las cuales se presentan en un 20% de pacientes inmunocompetentes y hasta en un 60% de inmunocomprometidos. La principal localización de una TBC extrapulmonar es a nivel pleural, seguida del compromiso ganglionar, urogenital y osteoarticular, siendo el resto de las localizaciones muy infrecuentes. Para esos casos la tomografía computada (TC) es el estudio por imágenes de elección para el diagnóstico y control, además de ser una herramienta muy útil para la detección de complicaciones.

Tuberculosis (TB) is an infectious disease of high morbility and mortality in Chile and in the world. It is the second cause of death due to infectious causes in the world, and is considered of high relevance to public health. TB is caused by a highly pathogenic and virulent bacterium denominated mycobacterium tuberculosis. Nowadays, there are effective protocols for detection and treatment of this disease, which make it preventable and curable. Diagnosis is reached by specific bacteriological studies in the presence of a clinical epidemiological suspicion. Nevertheless, imagining methods are almost an obligatory part of tuberculosis study and control. Since the lung is the target organ of TB, chest X-ray is commonly used as a support for diagnosis, which is very useful in case of pulmonary TB because it provides characteristic findings to guide diagnosis. It is important to highlight that the mycobacterium tuberculosis has a high potential for dissemination by contiguity, via lymphatic and/or haematogenous, the latter being the cause of the majority of extrapulmonary TB, which are presented in 20% of immunocompetent patients and by up to 60% of immunocompromised. The main site of extrapulmonary TB is into the pleural space, followed by the lymph node, urogenital and osteoarticular involvement, the remainder being infrequent localizations. In these cases, a computed tomography (CT) study based on the selection of images, is the tool used for diagnosis and control, which is also useful for the detection of complications.

Genitourinary tuberculosis - a rare presentation of a still frequent infection in renal transplant recipients.

Mycobacterium tuberculosis infection in renal transplant recipients is associated with significant morbidity and mortality. Genitourinary tuberculosis is a less frequent presentation and a high level of suspicion is needed to avoid treatment delay. Management is challenging due to the interaction of calcineurin inhibitors with antituberculous medications and the known side effects of these drugs, with higher prevalence in this population. The authors present a case of a renal transplant recipient with urinary and constitutional symptoms whom is diagnosed with tuberculosis after a prostatic biopsy in an already disseminated stage and develops hepatotoxicity to antituberculous therapy.

PIURIA ESTÉRIL / Sterile Pyuria

La Piuria estéril es una condición altamente frecuente en la población. Reporta una prevalencia del 29,9% en adultos y del 28,8% en niños, con un registro significativamente menor en hombres (12,8%). Se define como la presencia de 10 o más leucocitos por cada mL en una muestra de orina sin centrifugar, leucocitos en tinción Gram, el reporte positivo de prueba de esterasa leucocitaria y 3 o más leucocitos por campo de alto poder en orina centrifugada; en ausencia de bacterias y urocultivo negativo. Se pueden dividir sus causas entre infecciosas y no infecciosas. Dentro de las causas infecciosas, se ha asociado clásicamente con la tuberculosis urogenital causada por el del bacilo Mycobacterium tuberculosis, enfermedad que se reconoce como la segunda forma de tuberculosis extra pulmonar, aunque existen muchas otras infecciones, condiciones sistémicas y estructurales que pueden producir este hallazgo en el uroanálisis. Esto representa un desafío para el clínico, quien debe basar su aproximación diagnóstica en el levantamiento de una adecuada historia clínica y un prolijo examen físico. En ese contexto, la presente revisión narrativa persigue como objetivo dar a conocer las diferentes causas de la Piuria estéril teniente a describir una aproximación clínica para su abordaje diagnóstico.

Sterile pyuria is a highly prevalent condition in the population, with a prevalence of 29.9% in adults and 28.8% in children, being significantly lower in men with 12.8%. This condition is defined as the presence of 10 or more leukocytes per mL of a urine sample without centrifugation, Gram stain leukocytes, positive leukocyte esterase test, 3 or more leukocytes per high power field in centrifuged urine; In the absence of bacteria and negative urine culture. Their causes can be divided into infectious and non-infectious. Within the infectious causes, this finding has been classically associated with urogenital tuberculosis caused by that of the bacillus Mycobacterium tuberculosis, representing the second form of extra pulmonary tuberculosis, occurring in up to 20% of cases with pulmonary tuberculosis, although there are many other infections, conditions Systemic and structural factors that can produce this finding in uroanalysis, posing a challenge for the clinician, who must base his diagnostic approach on an adequate clinical history and a thorough physical examination. This narrative review aims to make known the different causes of sterile pyuria and thus describe a clinical approach for its diagnostic approach.

Genitourinary tuberculosis - a rare presentation of a still frequent infection in renal transplant recipients / Tuberculose genitourinária - uma apresentação rara de uma infeção ainda frequente nos doentes transplantados renais

Abstract Mycobacterium tuberculosis infection in renal transplant recipients is associated with significant morbidity and mortality. Genitourinary tuberculosis is a less frequent presentation and a high level of suspicion is needed to avoid treatment delay. Management is challenging due to the interaction of calcineurin inhibitors with antituberculous medications and the known side effects of these drugs, with higher prevalence in this population. The authors present a case of a renal transplant recipient with urinary and constitutional symptoms whom is diagnosed with tuberculosis after a prostatic biopsy in an already disseminated stage and develops hepatotoxicity to antituberculous therapy.

Resumo A infeção por Mycobacterion tuberculosis nos doentes transplantados renais está associada a morbilidade e mortalidade significativas. A tuberculose genitourinária é uma apresentação menos frequente desta infeção e é necessário um elevado índice de suspeição para evitar atraso no diagnóstico e tratamento. A abordagem terapeutica é desafiante dada a interação dos inibidores da calcineurina com os tuberculostáticos e os vários efeitos secundários destes fármacos, mais prevalentes nesta população. Os autores apresentam um caso de um doente transplantado renal com sintomas urínários e constitucionais que é diagnosticado com tuberculose após biópsia prostática e que desenvolve hepatotoxicidade à terapeutica.

[Genital tuberculosis and pregnancy to term. Case report]. / Tuberculosis genital y embarazo a término. Reporte de caso.

Tuberculosis continues to be a worldwide public health issue, known as "the great pretender" resembling many diseases. Overall 1% of women infected with Mycobacterium species develop genital tuberculosis (GT) which is widespread more commonly during their fertility age, 20-40 years old. GT is the second most common cause of extra pulmonary tuberculosis. One of the clinical manifestations in these patients is Infertility; with a poor prognosis of a successful pregnancy even with a correct diagnosis, medical and/or surgical treatment. Most pregnancies result in ectopic pregnancies or abortions. In low income countries GT may account for 5-20% of infertility cases. It was widely believed that pregnancy represented a period of risk to women infected with tuberculosis; and actually abortion is suggested. We report a case of a 21 year old female patient who came to the General Hospital Dr. Miguel Silva in the city of Morelia, Michoacán with the diagnosis of late puerperium postpartum complicated with retained placental tissue to perform a uterine curettage. The patient had fever and anemia for which we had to perform a laparotomy exploration of the doubt of uterin perforation; the surgical findings were pathognomonic of GT for which we continue to realize Hysterectomy. The macro and microscopically pathologic findings consists in GT, confirming the diagnosis with Ziehl-Neelsen acid stain. GT findings must always be differentiated from ovarian cancer.

Review of genitourinary tuberculosis with focus on end-stage renal disease.

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss.

Review of genitourinary tuberculosis with focus on end-stage renal disease / Revisão acerca da tuberculose genitourinária com foco na insuficiência renal crônica terminal

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss.

A tuberculose (TB) é um problema atual de saúde pública, persistindo como a causa mais comum de óbito por doenças infecciosas. Estudos recentes indicam que a TB genitourinária é a terceira forma mais comum de doença extra-pulmonar. O diagnóstico da TB renal pode ser suspeito na presença de cistite bacteriana não-específica associada a falha terapêutica ou com exame de urina apresentando leucocitúria persistente na ausência de bacteriúria. Relatamos o caso de um paciente de 33 anos, sexo masculino, que apresentou na admissão insuficiência renal crônica terminal secundária à TB renal, que tinha história prévia de TB pulmonar, com importantes achados radiológicos. O diagnóstico foi baseado nos achados clínicos apesar de todas as culturas terem sido negativas. Tratamento empírico com drogas tuberculostáticas foi iniciado e o paciente evoluiu estável. Foi de alta assintomático, mas sem recuperação da função renal. Ele encontra-se em hemodiálise três vezes por semana. A TB é uma causa importante de doença renal e pode levar à perda irreversível da função renal.

Manifestações clínicas da tuberculose pleural, ganglionar geniturinária e do sistema nervoso central / Clinical Manifestations of Tuberculosis in the Pleura, Lymph Nodes,Urogenital System, and Central Nervous System

A tuberculose persiste como uma importante causa de morbidade e mortalidade mundial. Apesar de a forma pulmonar ser a apresentação mais importante e frequente, o acometimento extrapulmonar ocorre em aproximadamente 10-20% dos casos e em até 60% nos imunocomprometidos. Revisamos as principais manifestações clínicas dos mais importantes acometimentos extrapulmonares da tuberculose em nosso meio. O comprometimento pleural, ganglionar e urogenital são os mais comuns em nosso meio, além da importância do comprometimento do sistema nervoso central. A tuberculose costuma manifestar-se clinicamente como enfermidade subaguda a crônica, com sinais sistêmicos clássicos de febre baixa vespertina, emagrecimento e astenia, além daqueles que são dependentes do órgão afetado. Algumas dessas manifestações são revistas e descritas, lembrando, porém, que não existe quadro clínico patognomônico da enfermidade e que essa deve ser sempre lembrada no diagnóstico diferencial em nosso meio

Tuberculosis persists as a major cause of morbidity and mortality worldwide. Although the pulmonary form is more common and severe, the extrapulmonary form occurs in 10-20% of all cases and in up to 60% of cases in which the host is immunocompromised. This paper reviews the principal clinical manifestations of the most common types of extrapulmonary tuberculosis. Extrapulmonary tuberculosis most often afects the pleura, lymph nodes, urogenital system, and central nervous system, the last being the most common. In most cases, extrapulmonary tuberculosis is a clinically subacute or chronic disease, with symptoms speciic to the afected organ, as well as systemic signs, including a low fever, weight loss, and asthenia. Although some of these manifestations have been described, there is no pathognomonic clinical proile of the disease, which should always be included in the diferential diagnosis

Tuberculose urogenital: um diagnóstico desafiador / Urogenital tuberculosis: a challenging diagnosis

Realizar revisão de literatura científica sobre o histórico da tuberculose (TB), história natural da TB no ser humano, TB extrapulmonar em sua forma urogenital, incluindo epidemiologia, diagnósticoe tratamento.

Review of scientific literature on the history of tuberculosis (TB), the natural history of TB in humans, extrapulmonary TB in urogenital form, including epidemiology, diagnosis and treatment.

A better understanding of urogenital tuberculosis pathophysiology based on radiological findings.

PURPOSE: To assess the radiological findings of urogenital tuberculosis (UGT) in patients at different disease stages, for a better understanding of its pathophysiology. PATIENTS AND METHODS: We retrospectively reviewed the radiological exams of 20 men (median age 41 years; range: 28-65) with urogenital tuberculosis diagnosis. The patients were classified in the following groups: (1) bilateral renal tuberculosis with predominantly parenchymatous involvement; (2) unilateral renal tuberculosis; (3) unilateral renal tuberculosis with bladder tuberculosis and (4) bilateral renal tuberculosis with bladder tuberculosis. RESULTS: One AIDS patient had multiple bilateral renal tuberculosis abscesses (group 1). Six patients had unilateral renal tuberculosis with hydronephrosis due to stenosis and thickening of the collecting system, without involvement of the bladder or contralateral kidney (group 2). Six patients had bladder tuberculosis with diffuse thickening of the bladder wall, with one very low or no function kidney while the other kidney was normal (group 3). Seven patients had bladder tuberculosis associated to a very low or no function kidney with the other kidney with high-grade vesicoureteral reflux-associated ureterohydronephrosis (group 4). In two patients, sequential exams showed evolution of tuberculosis from a unilateral renal and ureteral lesion to contracted bladder and dilatation of the contralateral kidney secondary to high-grade reflux. CONCLUSIONS: UGT may have variable radiological presentations. However, in two of our cases we have seen that tuberculosis involvement of the urinary tract may be sequential. Further evidences are necessary to confirm this hypothesis.