Ewha Med J.  2013 Mar;36(1):67-71. 10.12771/emj.2013.36.1.67.

Disseminated Tuberculosis in a Patient with Chronic Renal Failure

• Jung KY
• Na SK
• Yun HW
• Song HE
• Ryu JH
• Ryu DR

• KMID: 2284018
• DOI: http://doi.org/10.12771/emj.2013.36.1.67

Abstract

Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.

Keyword

Chronic renal failure; Disseminated tuberculosis

MeSH Terms

Biopsy
Fever
Humans
Jaundice, Obstructive
Kidney Failure, Chronic
Liver
Tuberculosis

Figure

• 

  Fig. 1 Initial radiologic findings. Chest X-ray shows pulmonary edema and cardiomegaly, while there is no evidence of pulmonary or miliary tuberculosis (A). Hepatomegaly and splenomegaly without abnormal enhancement in the liver is noted in abdominal computed tomography (B).

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  Fig. 2 Histopathologic findings of the liver. There are scattered non-caseating granulomas with focus of multinucleated giant cell (A: H&E, ×200). The acid-fast bacilli are stained (B), and arrow indicates the bacilli (Ziehl-Neelsen stain, ×400).

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  Fig. 3 Chest radiographic images for the evaluation of orthopnea performed after 25 days of the start of anti-tuberculosis medication. Chest posterioranterior X-ray shows that focal consolidations are seen in right upper lung field (A). Active pulmonary tuberculosis is seen in right upper lobe (B), and right and left main bronchus is narrowing with enhanced wall thickening (C) in the chest computed tomography.

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