Sanches Inês, Pinto Cláudia, Sousa Mário, Carvalho Aurora, Duarte Raquel, Pereira Manuel
Serviço de Pneumologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Serviço de Pneumologia. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real. Portugal.
Acta Med Port. 2015 May-Jun;28(3):382-5. Epub 2015 Jun 30.
Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis, comprising 4 - 17% of extrapulmonary forms. The authors describe the case of a patient with recurrent urinary tract infections, without isolation of an infectious agent and without symptomatic resolution, despite antibiotic treatment. Imaging exams showed left ureteral stenosis with moderate hydronephrosis. The attempt of retrograde catheterization was impossible so we opted for percutaneous nephrostomy to renal relief. Microbiological urine analysis colleted by that way was positive for Mycobacterium tuberculosis complex. The patient started therapy with classical quadruple therapy and underwent nephrostomy for catheter placement. Despite therapeutic measures the patient required nephrectomy due to nonfunctioning kidney. Genitourinary tuberculosis is a diagnosis that should be considered in the presence of a persistent sterile pyuria.
泌尿生殖系统结核是肺外结核的第三常见形式,占肺外结核形式的4 - 17%。作者描述了一例反复出现尿路感染的患者,尽管进行了抗生素治疗,但未分离出感染病原体且症状未缓解。影像学检查显示左输尿管狭窄伴中度肾积水。逆行插管尝试失败,因此我们选择经皮肾造瘘以缓解肾脏压力。通过这种方式收集的尿液微生物学分析显示结核分枝杆菌复合群呈阳性。患者开始采用经典四联疗法治疗,并接受了肾造瘘置管术。尽管采取了治疗措施,但由于肾脏无功能,患者仍需进行肾切除术。在存在持续性无菌性脓尿的情况下,应考虑泌尿生殖系统结核的诊断。