Bhatt Manasvini, Soneja Manish, Tripathi Madhavi, Biswas Ashutosh
Junior Resident, Department of Medicine, All India Institute of Medical Sciences, New Delhi.
Associate Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2018 Dec 3;11(1):bcr2018227258. doi: 10.1136/bcr-2018-227258.
A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.
一名58岁免疫功能正常的女性出现发热及持续4个月的显著体重减轻。她有轻度苍白；其余检查无异常。检查发现贫血且炎症标志物升高。培养、血清学检查、尿常规检查、骨髓检查、增强CT及二维超声心动图检查均无异常。进行了18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG-PET/CT），结果显示双侧肾皮质有非典型的不均匀摄取。随后，尿液GeneXpert检测对利福平敏感呈阳性。她接受1类抗结核治疗后有反应。本报告讨论了泌尿生殖系统结核诊断中的挑战、传统诊断试验的低敏感性以及GeneXpert和18F-FDG-PET/CT扫描的潜在作用。
