Urogenital tuberculosis in a patient with AIDS: an unusual presentation.
BACKGROUND
A 38-year-old man with AIDS presented to hospital with a 3-month history of fevers, bilateral lumbar pain, dysuria and increased urinary frequency. Six years earlier he had received 6 months' treatment for pulmonary tuberculosis. At presentation, he was on antiretroviral therapy with a combination of efavirenz, stavudine and lamivudine.


METHODS
Physical examination, evaluation of HIV viral load, CD4 count, measurement of serum hemoglobin concentration, white blood cell count, urinalysis, urine culture for usual pathogens, direct smear and urine culture for Mycobacterium tuberculosis, chest radiography, abdominal CT, measurement of serum creatinine concentration and estimated creatinine clearance.


METHODS
Urogenital tuberculosis.


RESULTS
The patient's symptoms and radiological abnormalities persisted despite antibiotic therapy for presumed bacterial infection. After urine culture had confirmed M. tuberculosis infection, he was administered pharmacological treatment comprising isoniazid, rifampin, pyrazinamide and ethambutol for 2 months, with isoniazid and rifampin given for a further 7 months. His symptoms improved within a few days of initiating treatment. Six months after treatment started, CT revealed a nonfunctioning right kidney and a functional left kidney with areas of scarring. The patient refused right nephrectomy, and completed his pharmacological treatment. No evidence of disease recurrence was observed during 2 years of follow-up.
Figueiredo
André A
AA
Federal University of Juiz de Fora, Minas Gerais, Brazil. andreavaresef@gmail.com
Lucon
Antonio M
AM
Ikejiri
Diego S
DS
Falci
Renato
R
Srougi
Miguel
M
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D014389:Tuberculosis, Male Genital / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis
D000995:Antitubercular Agents