Genitourinary Tuberculosis in a Young Male With Advanced Human Immunodeficiency Virus (HIV) Diagnosed via Urinary Lipoarabinomannan Antigen (TB-LAM): A Case Report From a High-Burden Setting

Genitourinary tuberculosis (GU-TB) is a rare but significant manifestation of extrapulmonary tuberculosis, particularly among immunocompromised individuals. Diagnosis remains difficult in resource-limited settings where access to culture or advanced imaging is restricted. The World Health Organization recently endorsed the urinary lipoarabinomannan (TB-LAM) assay for early tuberculosis detection in people with advanced HIV. We report the case of a 29-year-old mestizo man from Peru with HIV diagnosed in 2018 who had discontinued antiretroviral therapy (ART) shortly after initiation. He reengaged with the Peruvian healthcare system in July 2025, presenting with persistent systemic symptoms, including night sweats, anorexia, and lower abdominal discomfort. Laboratory studies revealed a CD4 count of 237 cells/μL and a viral load of 1.59 million copies/mL. Urinalysis showed sterile pyuria and microscopic hematuria. Chest radiography revealed no pulmonary involvement. Renal ultrasound demonstrated increased parenchymal echogenicity with partial loss of corticomedullary differentiation. Given his immunosuppressed state and nonspecific presentation, a TB-LAM test was performed and returned positive. A diagnosis of GU-TB was established, and the patient was initiated on first-line anti-tuberculosis therapy with concurrent ART reintroduction. He demonstrated a favorable clinical response without immune reconstitution inflammatory syndrome (IRIS). This case highlights the diagnostic utility of TB-LAM in extrapulmonary TB among HIV-positive patients and underscores the need for clinical vigilance in high-burden, low-resource settings.