|Year : 2022 | Volume
| Issue : 2 | Page : 157-158
Extensive calcification in genitourinary tuberculosis misdiagnosed as ureteral calculi
Gurpremjit Singh1, Shiv Charan Navriya1, Sunil Kumar2
1 Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Urology, Raj Hospitals, Ranchi, Jharkhand, India
|Date of Submission||20-Jan-2022|
|Date of Decision||11-Mar-2022|
|Date of Acceptance||19-Mar-2022|
|Date of Web Publication||1-Apr-2022|
Shiv Charan Navriya
Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Ureteral calcification in genitourinary tuberculosis is extremely rare. A 36-year-old female presented with a diagnosis of right ureteral calculi. On further investigations, she was found to have a right nonfunctioning kidney with a suspected diagnosis of genitourinary tuberculosis which was confirmed on histopathology.
|How to cite this article:|
Singh G, Navriya SC, Kumar S. Extensive calcification in genitourinary tuberculosis misdiagnosed as ureteral calculi. Indian J Urol 2022;38:157-8
| Case|| |
A 36-year-old female was admitted with right flank pain, fever, and burning micturition. She was referred to us with a diagnosis of right ureteric calculi, based on an ultrasound of the abdomen. No flank tenderness was present in the physical examination. A urine examination revealed sterile pyuria. An X-ray of the kidney-ureter-bladder region showed calcification in the region of the right kidney and the right ureter [[Figure 1], arrows]. A tubercular-polymerase chain reaction of a urine specimen showed Mycobacterium tuberculosis. Antitubercular treatment was started, diethylenetriamine pentaacetate scan revealed a nonfunctioning right kidney. Robot-assisted right nephroureterectomy was done after patients' consent because of recurrent flank pain. The histopathology reported features of granulomatous inflammation of the kidney suggestive of tuberculosis.
|Figure 1: X-ray kidney-ureter-bladder showing calcifications in the kidney and ureter (arrows)|
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Genitourinary tuberculosis is commonly misdiagnosed given its nonspecific initial presentations. This case highlights the need for a high index of suspicion for diagnosing genitourinary tuberculosis. In the later stages of tuberculosis, calcification may predominate which destroys the kidney. The destructive effects of tubercular bacilli along with host immune defense mechanisms leading to granuloma formation further lead to calcium deposition. Ureteral calcification in tuberculosis is rare and presents as intraluminal cast. The ureter is not dilated and gradually leads to loss of renal function. The extensive calcification like in this index patient is very rare.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship: Nil.
Conflicts of interest: There are no conflicts of interest.
| References|| |
Merchant S, Bharati A, Merchant N. Tuberculosis of the genitourinary system – Urinary tract tuberculosis: Renal tuberculosis – Part I. Indian J Radiol Imaging 2013;23:46-63.
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Prakash J, Goel A, Sankhwar S, Singh BP. Extensive renal and ureteral calcification due to tuberculosis: Rare images for an uncommon condition. BMJ Case Rep 2013;2013:bcr2012008508.