Ushida Hiroshi, Kobori Goh, Maegawa Masanobu, Maekawa Shinya, Kaneko Yoshiyuki, Ohmori Kouhei, Nishimura Kazuo
Department of Urology, Osaka Red Cross Hospital.
Hinyokika Kiyo. 2003 Jun;49(6):321-3.
A case of urinary and miliary tuberculosis in a 51-year-old male is reported. The patient with the complaint of low grade fever at night and appetite loss had visited another clinic. Laboratory data showed renal failure (serum creatinine 3.9 mg/dl, BUN 35.1 mg/dl) and he was referred to our hospital. Ultrasonography and computed tomography (CT) revealed bilateral hydronephrosis. Therefore we suspected postrenal renal failure. We performed cystoscopy in order to perform retrograde pyelography and to indwell double J stent. The bladder showed yellow-whitish nodules all over the bladder. Tuberculous bacilli were detected in the urine by smear, polymerase chain reaction (PCR) and culture. Chest radiography and CT revealed multiple granular nodules and so diagnosed miliary tuberculosis. Immediately combination chemotherapy of with isonicotinic acid hydrozide, rifapicin, ethanbutal and pirazinamide was administered. Histopathology by bladder biopsy showed epithelioid cell granuloma. Chemotherapy was effective, but the vesical capacity was contracted to less than 50 ml, and we suspect that the patient will need vesical augmentation.
报告了一例51岁男性的泌尿及粟粒性结核病例。该患者因夜间低热和食欲减退前往另一家诊所就诊。实验室检查显示肾衰竭（血清肌酐3.9mg/dl，尿素氮35.1mg/dl），随后被转诊至我院。超声检查和计算机断层扫描（CT）显示双侧肾积水。因此，我们怀疑是肾后性肾衰竭。为了进行逆行肾盂造影和留置双J支架，我们进行了膀胱镜检查。膀胱内可见遍布的黄白色结节。通过涂片、聚合酶链反应（PCR）和培养在尿液中检测到结核杆菌。胸部X线和CT显示多个颗粒状结节，诊断为粟粒性结核。立即给予异烟肼、利福喷丁、乙胺丁醇和吡嗪酰胺联合化疗。膀胱活检的组织病理学显示上皮样细胞肉芽肿。化疗有效，但膀胱容量缩小至小于50ml，我们怀疑患者需要进行膀胱扩大术。
