Beyond the Lungs: A Case of Disseminated Renal Tuberculosis

Introduction: Renal tuberculosis is a rare form of extrapulmonary tuberculosis. The infection arises from hematogenous spread of Mycobacterium tuberculosis (MTB) from a primary lung source. Infected individuals can present with a genital tuberculous ulcer on the penile shaft, or in the female genital tract, which can develop upon primary contact with MTB pathogen after sexual intercourse. Infection results in formation of granulomas that can remain dormant for decades; an immunocompromised state can result in disease activation and spread. In the renal system reactivated granulomas can form cavitary lesions which can spread to the calyceal system allowing the infection to descend through the rest of the renal anatomic route. Case Description: A 41-year-old male from Senegal, had no pertinent medical history and presented with complaints of generalized fatigue, hemoptysis, night sweats, chills and unintentional weight loss for a duration of 2 months. Physical exam revealed HR of 145 bpm. increased tactile and auscultatory vocal fremitus more pronounced over the right lung field, and left upper quadrant tenderness without guarding. investigations revealed white cell count of 10.85 x 19(3)/MCL, hemoglobin 10.6 g/dL, platelets 483, sodium 123 mmol/L, potassium 3.6 mmol/L, chloride 84 mmol/L, bicarb 29 mmol/L, and normal renal function test. Sputum positive for acid-fast bacilli. Urine studies showed WBC of 26.8 /HPF, trace protein and moderate leukocyte esterase, acid-fast bacilli positive. CXR and CT scan of the chest showed diffuse granular/nodular opacities within bilateral lungs. CT abdomen and pelvis revealed patchy areas of cortical/wedge-shaped hypodensities within renal parenchyma. Discussion: Urogenital TB is seen mostly in endemic areas of tuberculosis, amongst younger males. it comprises 40% of extrapulmonary TB infections, although up to 20% of infected patients with pulmonary TB end up developing urogenital tuberculosis. Clinical manifestations of the disease vary including fever, dysuria, hematuria, urgency, back pain. Diagnosis entails thorough history taking and clinical examination, alongside detection of acid-fast-bacillus in sputum, urine, lymph node biopsy, cerebrospinal fluid, or pleural fluid. Radiographic evidence can reveal areas of wedge-shaped renal infarction, if left untreated it can end up in formation of fibrotic necrotic tissue referred to as “putty or chalky kidney”.