ABSTRACT
@#Genitourinary tuberculosis (GUTB) represents a critical aspect of extra‑pulmonary tuberculosis (TB). While it is the second most common form of this disease, its diverse clinical presentations pose a substantial challenge. This report, titled “Varied Clinical Presentations of Genitourinary Tuberculosis: A Case Series from a Tertiary Philippine Hospital,” aims to shed light on the intricacies of GUTB diagnosis, treatment, and its broader implications. In this case series, we present five unique clinical scenarios. Cases 1, 2, and 3, having completed TB treatment, developed spontaneous genitourinary fistulae. Case 4 was initially managed as interstitial cystitis, while Case 5 underwent diverticulectomy for a urethral diverticulum. The diagnosis of GUTB as the underlying cause in these cases, despite conventional treatment, highlights the diagnostic challenges posed by this disease. All five patients, experienced irritative voiding symptoms and recurrent urinary tract infections with limited improvement following antibiotic therapy. Imaging studies consistently revealed upper urinary tract involvement. Importantly, only one case exhibited histologic evidence of granuloma suggestive of GUTB, and microbiologic confirmation of Mycobacterium tuberculosis infection was obtained in only two cases. This underscores the need for a multidimensional diagnostic approach. The findings in this case series emphasize that GUTB diagnosis, often reliant on clinical findings supported by imaging studies and suggestive cystoscopy findings, remains critical for prognosis, even in the absence of microbiologic confirmation. Beyond the individual cases, this series offers insights into the complexity of GUTB, raising questions about the overall management and implications for TB control.
Subject(s)
TuberculosisABSTRACT
Endobronchial tuberculosis(EBTB)is a special form of TB which is associated with significant morbidity and potential mortality. EBTBis the infection of tracheobronchial tree, and continues to remain challenging for clinicians to diagnose. The incidence of EBTBhas been reported to be 5.8% to 30% in people with pulmonary TB. 60-year-old male, chronic smoker presented with complaints of dyspnea, cough with expectoration and sore throat for 2 weeks. General examination showed patient to have pallor and respiratory system examination showeddecreased breath sounds in left infraaxillary region and bilateral crepitations. Routine blood investigations done showed decreased hemoglobin levels, elevated total leukocyte count, ESR. Sputum AFB was negative. Mantoux-15mm induration. Chest X-ray showed homogenous opacities over the left lower zone and elevated right diaphragm. CT thorax done showed a subsegmental peripheral soft tissue density 4.3×2.2 cm in the inferior lingula segment. Bronchoscopy showed whitish plaques over the anterior tracheal wall near carina and over left main bronchus. Endobronchial tissue growth seen occluding the lingula bronchus. Biopsy was taken and histopathology showed a granulomatous lesion, BAL Gene Xpert was positive for MTB. Patient was started on 3 tablets ATT. Clinicians need to be vigilant in patients who are AFB smear negative, with symptoms; bronchoscopy should be considered in those selected cases.
ABSTRACT
Ureterocoele is a cystic dilatation of the lower part of the ureter. One of its presentations in the adult population is the presence of a stone, usually a solitary stone, inside the ureterocoele. Authors present a rare case of Ureterocoele with stone in it managed with transurethral deroofing and cystolitholapaxy. This work has been reported in line with the SCARE criteria.