ABSTRACT- A 76 years old male presented with complaints of fever, weight loss and anorexia for three months and increased frequency and urgency of urine for 20 days. Physical examination of abdomen showed a lump in right paraumblical region and extending up to inguinal and hypogastrium on right side. Postero-anterior view of chest radiograph was normal. Ultrasound and Computed tomography (CT) of abdomen revealed a giant exophytic right renal cortical cyst of 9.84x9.70 cm (volume 336 mL) size arising from lower pole. Ultrasound guided aspiration of the cystic lesion revealed yellowish coloured, purulent pus of about 280 mL. Ziehl-Neelsen staining and PCR tests of the pus was positive for Mycobacterium tuberculosis. Gram’s staining and pus culture was negative for other microorganisms. Patient responded to anti-tubercular treatment and finally considered as primary tubercular giant exophytic renal cortical cyst. To our knowledge, this common entity is an extremely rare manifestation.
Key-words- PCR, Giant cyst, Mycobacterium tuberculosis, Ultrasound and Computed tomography (CT)
Tuberculosis (TB) continues to be a major health problem in South Asia. Nearly one third of global tuberculosis burden is contributed by India alone . Renal TB is the most common site of extra-pulmonary TB and comprises 15-20% of all extra-pulmonary tuberculosis . Genitourinary tuberculosis is the second most common form of extra pulmonary tuberculosis after lymph node involvement . Kidney is usually the primary organ infected in urinary disease, and other parts of the urinary tract become involved by direct extension.This infection can result in caseation and destruction of renal mass and healing can lead to strictures, obstruction and infection causing renal func-tional loss and failure .
A76 years-old male presented with complaints of fever, cough, weight loss, anorexia for three months. He had frequency and urgency of urine for 20 days. There was no past history of pulmonary tuberculosis. Physical examination of abdomen showed right side abdominal swelling. PA view of chest skiagram was normal. USG reveals a large exophytic right renal cortical cyst of 9.84x9.70cm arising from the lower pole (Fig. 1). Plain CT-abdomen revealed a large exophytic right renal cortical cyst arising from lower pole. (Fig. 2) Purulent pus was aspirated from cyst and send for bacterial Culture, Elisa for hydatid disease, Ziehl-Neelsen staining and PCR test. Pus culture and Elisa for hydatid disease was negative. Ziehl-Neelsen staining and PCR tests of the pus was positive for Mycobacterium tuberculosis. An ECG finding was normal. Routine investigation including complete blood analysis, blood sugar, and liver function tests were normal limit. Renal function was deranged as evidenced by raised urea level of 34.8 mg/dl and serum creatinine 1.6 mg/dl. Urine culture was shown growth of Escherichia coli. Routine urine examination showed plenty of pus cells. Patient consent was ob-tained.
|How to cite this article:
Singh S, Kumar M, Kumar A, Kumar S, Sankhwar SN: Primary Renal Tuberculosis Presented as Giant Cyst at Lower Pole of
Kidney. Int. J. Life. Sci. Scienti. Res., 2017; 3(4): 1148-1150. DOI:10.21276/ijlssr.2017.3.4.8
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