Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Indian J Tuberc. 2020 Oct;67(4):564-566. doi: 10.1016/j.ijtb.2020.07.005. Epub 2020 Jul 11.
Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria. 12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.
结核病（TB）是由结核分枝杆菌引起的多系统疾病，可累及任何器官。在任何出现涉及多个器官系统的临床特征的儿童中，结核病都是一个重要的鉴别诊断。对于印度等流行国家来说尤其如此。泌尿生殖系统结核病（GUTB）占所有肺外结核病病例的 27%。我们报告了一例不常见的播散性结核病病例，涉及肾脏并表现为肉眼血尿。一名 12 岁女孩，因持续一个月的反复发作性肉眼血尿就诊。她为此接受了多次红细胞悬液输注。她有慢性营养不良。肾脏超声和肾多普勒检查正常。由于持续血尿，进行了 CT 尿路造影检查，结果显示提示乳头坏死和膀胱炎的特征。结核检查显示双侧肺门周围区域存在多个阴影，同时结核菌素试验阳性。痰液 AFB 检查阳性，发现结核杆菌。尿液样本也被送去进行 CBNAAT，结果显示结核杆菌对利福平敏感。诊断为播散性结核病后，开始进行抗结核治疗（ATT），随后进行膀胱镜下切除炎症性膀胱壁组织。膀胱黏膜活检证实为干酪样肉芽肿，提示结核性膀胱炎。患者在完成 ATT 后恢复良好，无症状。
