Tourchi A, Ebadi M, Hosseinzadeh A, Shabaninia M
Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Abstract

Hematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug abuse. Blood tests indicated anemia, leukocytosis, elevated CRP and ESR and mild hyponatremia; hematuria, moderate bacteriuria and 2+ proteinuria on urine analysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis; which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and HCV seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of hematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed to after appropriate treatment of tuberculosis.

Int J STD AIDS. 2013 Aug 1. [Epub ahead of print]
PMID:23970650 [PubMed - as supplied by publisher]