Quaresma Filipa, Bentes Jesus Margarida
Department of Internal Medicine, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
BMJ Case Rep. 2017 Aug 10;2017:bcr-2017-219579. doi: 10.1136/bcr-2017-219579.
A 48-year-old man with a 4 months history of asthenia, anorexia, 10 kg weight loss and 1 month of hematuria and dysuria was admitted to another hospital for sudden muscular weakness. He was found to have areflexic tetraparesis and was referred to our hospital.On admission, he was bradycardic, tachypneic, with flaccid tetraplegia. Laboratory results showed metabolic acidemia, severe hyperkalemia and hyponatremia, acute renal dysfunction and sterile pyuria. After hyperkalemia correction, the neurological symptoms resolved.On the second day, he became febrile and chest radiograph and CT images showed a pulmonary bilateral reticulomicronodular pattern, left hydronephrosis and diffuse bladder wall thickening. Disseminated tuberculosis was considered as diagnosis by the coexistence of this imagiologic alterations and sterile pyuria. Acid-fast test for was negative, but the urine culture became positive after 2 weeks.Antituberculosis treatment was started. One year later, he was asymptomatic and the structural urinary lesions had disappeared.
一名48岁男性，有4个月的乏力、厌食病史，体重减轻10千克，并有1个月的血尿和排尿困难，因突发肌无力入住另一家医院。他被发现有反射消失的四肢轻瘫，随后被转诊至我院。入院时，他心动过缓、呼吸急促，伴有弛缓性四肢瘫。实验室检查结果显示代谢性酸血症、严重高钾血症和低钠血症、急性肾功能不全及无菌性脓尿。高钾血症纠正后，神经症状消失。第二天，他发热，胸部X线片和CT图像显示双肺网状微结节样改变、左肾积水及膀胱壁弥漫性增厚。鉴于这些影像学改变与无菌性脓尿并存，考虑诊断为播散性结核病。结核菌素试验为阴性，但尿培养2周后呈阳性。开始抗结核治疗。1年后，他无症状，泌尿系统结构病变消失。
