title: Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.
abstract: Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.
authors: Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Ali
authors: A
authors: Tourchi
authors: Maryam
authors: M
authors: Ebadi
authors: Alireza
authors: A
authors: Hosseinzadeh
authors: Mahsa
authors: M
authors: Shabaninia
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome; D014389:Tuberculosis, Male Genital / Q000188:drug therapy / Q000209:etiology*; D014545:Urinary Calculi / Q000628:therapy*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology*
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents
keywords: AIDS; HIV; Mycobacterium tuberculosis; disseminated tuberculosis; extracorporeal shock-wave lithotripsy; viral disease