Miliary Tuberculosis with Addisons Disease - in old case of pulmonary tuberculosis, and tuberculosis of seminal vesicles - A rare case report

Addison's disease is a rare endocrinal disorder that was first described by Thomas Addison in 1855. Addison抯 disease occurs as a result of a lack of production of adrenocortical hormones, which is a rare but fatal disease if left untreated. The two most common causes of Addison's disease are autoimmune adrenalitis and tuberculosis which refer to hypoadrenalism caused by total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhoea, hypotension, and hyper pigmentation of the skin. A substantial proportion of patients presenting with extra-pulmonary tuberculosis (TB) have urogenital TB (UG-TB), which is easily under diagnosed because of non-specific symptoms, which are chronic and have cryptic protean clinical manifestations. Most of the clinician are not aware of the possibility of UG � TB. Calcification of seminal vesicle found in this case is a rare condition, which is commonly associated with diabetes, hyperparathyroidism, and genitourinary tuberculosis. We here in report a rare case of adrenal insufficiency due to miliary tuberculosis involving adrenal gland, old pulmonary tuberculosis and genitourinary tuberculosis (seminal vesicles calcification) in a 31 year old male person. He presented with multiple episodes of vomiting, and giddiness which wasalso accompanied with atypical hyperpigmentation. His symptoms resolved after starting anti tuberculous therapy.

Varied clinical presentations of genitourinary tuberculosis: A case series at a tertiary Philippine hospital / Philippine Journal of Obstetrics and Gynecology

@#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.

A rare case of primary disseminated multi-drug resistant tuberculosis

Tuberculosis (TB) is the commonest cause of infection-related death globally. Disseminated tuberculosis (TB) is a life-threatening disease which results from the hematogenous spread ofMycobacterium tuberculosis. Genitourinary tuberculosis(GUTB) is usually caused as a result of the hematogenousspread of the mycobacteriaduring the initial infection. The patient's clinical presentation may vary from asymptomatic to non-specific symptoms related to the organ involved and may also overlap with urinary tract infections caused by other pathogens hence delaying the diagnosis. Here we report one such case where the vague symptoms of the patient and absence of respiratorysymptoms delayed the diagnosis of primary disseminated multi-drug resistant(MDR) tuberculosis.

Utility of GeneXpert in the diagnosis, reliance on urine microscopy and clinical characteristics of genitourinary tuberculosis at a tertiary care hospital

Background: One-third of the world's population is infected with tuberculosis (TB) with new infection occurring every second. In humans, TB is primarily caused by Mycobacterium tuberculosis(MTB). Genitourinary TB (GUTB) is still a major health problem in many developing countries including India and had been declared by the World Health Organisation as 'public health emergency' in 1993. Materials and Methods: This is a prospective study conducted at a tertiary care hospital involving 46 patients who presented with clinical feature suggestive of GUTB – urine specimens of these 46 patients were analysed for acid–fast bacilli (AFB), AFB culture, GeneXpert, and other relevant investigations were done to reach the diagnosis. Majority of patients were female (65.25%). This is especially relevant to rural and low socioeconomic areas in developing countries where women's health is worse than men's (in terms of nutrition); women's risk of disease may be increased. Most of our patients were above 30 years of age and exhibited nonspecific symptoms such as dysuria, haematuria and frequency. All patients were put on antitubercular drugs and followed as per the guidelines. Conclusion: The sample size in the present study is small to arrive at a brisk inference, but it may safely be postulated that yield of detection for GeneXpert may be improved using multiple sampling, especially the early morning ones. It is also pertinent to mention here that GeneXpert may not be able to pick up mutant genomes.

Ileal Ureter for Panureteral Stricture of Tubercular Origin.

Genitourinary tuberculosis (GUTB) is the second most common extrapulmonary tuberculosis (TB) after tubercular lymphadenitis. About 8 to 15% of TB patients suffer from GUTB.1 The most common age of GUTB presentation is the fourth decade and the commonest organ involved is kidney. We report here an unusual case of 20-year-old male patient with panureteral tuberculous stricture for which he underwent successful ileal ureter replacement.

Tuberculosis genitourinaria en paciente con sida / Genitourinary tuberculosis in an AIDS patient

Introducción: la tuberculosis es una enfermedad con una alta prevalencia en los países en vías de desarrollo. Entre los casos de tuberculosis extrapulmonar, la tuberculosis genitourinaria es común y esta situación se acentúa en los pacientes con sida. Objetivo: describir las características clínicas de un paciente que presentó tuberculosis genitourinaria detectada mediante el empleo de la reacción en cadena de la polimerasa. Presentación del caso: paciente masculino de 34 años de edad, seropositivo al virus de la inmunodeficiencia humana desde 2004, con antecedentes de tuberculosis pulmonar, que ingresa en junio de 2014 en el Hospital del Instituto de Medicina Tropical Pedro Kourí refiriendo fiebre de alrededor de dos meses de duración, intermitente, vespertina, acompañada de sudoraciones profusas y pérdida de peso importante. Además, se constata la presencia de disuria desde el comienzo de la fiebre. Recibió varios tratamientos con antibióticos sin respuesta. Se detecta Mycobacterium tuberculosis en la orina del paciente mediante la reacción en cadena de la polimerasa. Tres meses después, es reevaluado y se encuentra afebril, con aumento de peso, evolución clínica favorable y continúa con la primera fase de tratamiento anti-tuberculosis. Conclusiones: el evento ocurrido en este caso sugiere que los facultativos deben pensar en el diagnóstico de la tuberculosis genitourinaria en los pacientes con sida(AU)

Introduction: tuberculosis is highly prevalent in developing countries. Genitourinary tuberculosis is a common type of extrapulmonary tuberculosis, particularly in AIDS patients. Objective: describe the clinical characteristics of a patient with genitourinary tuberculosis detected by polymerase chain reaction. Case presentation: amale 34 year-old patient seropositive for human immunodeficiency virus since the year 2004 and a history of pulmonary tuberculosis is admitted in 2014 to the hospital at Pedro Kouri Tropical Medicine Institute. The patient had had intermittent vespertine fever for about two months as well as profuse sweating and considerable weight loss. Dysuria had also been present since the onset of fever. The patient had received several antibiotic treatments with no response. Mycobacterium tuberculosis was detected in the patient's urine by polymerase chain reaction. Re-evaluation performed three months later found that the patient was afebrile, had gained weight and his clinical evolution was favorable. The patient continues at the first stage of tuberculosis treatment. Conclusions: the event described suggests that physicians should consider genitourinary tuberculosis in their evaluation of AIDS patients(AU)

A 14-year-old boy with Isolated Tuberculous Orchitis.

The genitourinary tract is the most common extrapulmonary site affected by tuberculosis1. The male genital organs are involved in more than 50% of patients2. The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens3. An isolated tuberculous orchitis without epididymal involvement is rare. This case report describes extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made by FNAC of the testis. It provides a successful diagnosis, thereby preventing unnecessary orchidectomy.

A Study of the Isolation of Tubercle Bacilli from the Patient's Urine with Genitourinary Tuberculosis by the Inoculation into the Korean Chipmunks / 대한비뇨기과학회지

The detection of the tubercle bacilli is absolutely necessary to make definite diagnosis of patients with genitourinary tuberculosis. Recently it has been reported that the detection rate of tubercle bacilli from the patient's urine is decreasing because of abuse of the anti-tuberculous drugs and the resistance developed in the experimental animals such as mouse and guinea pig (Marks, 1972). Therefore the necessity of the development of better diagnostic methods has been mandatory. Recently it was reported that the Korean chipmunks(Tamias sibiricus asiaticus. Gmelin) are highly susceptible to tubercle bacilli (Chang et al., 1971). The specific objection of this study is to pursue the possibility of using the chipmunks for the early diagnosis of genitourinary tuberculosis. Twenty-four hour urines of 34 patients with suspected genitourinary tuberculosis were tested for tubercle bacilli with smear, culture, and inoculation ink chipmunks and mice intraperitoneally. The results are briefly summarized as follows: 1. 18 cases out of 34 patients with suspected genitourinary tuberculosis were confirmed to be positive by any means of stained smear, culture and animal inoculation. Of 18 proved genitourinary tuberculosis. 12 cases were confirmed by smear, culture and mouse inoculation, and on the other hand. 14 cases by chipmunks inoculation. 2. In the group of chipmunks inoculation, 8 cases were found to be positive on the 10th day and 14 cages on the 20th day. 3. These findings suggest that the period required for the detection of tubercle bacilli was shorter and the positive rate was higher than that of other animals and other methods. For the clinical applications of the Korean chipmunks as a diagnostic tools, further effort is considered to be necessary.

Statistical and Clinical Observation on Patient of Tuberculosis of Genito-Urinary Tract During the Period of 3 Years and 6 Months / 대한비뇨기과학회지

A Statistical survey and clinical observation was made on 165 in patients of Genito-Urinary tuberculosis during the period of 3 years and 6 months, 1967~1970, in the Department of Urology, 17th Army Hospital. The results of the observations are summarized as follows : the majority of the patients (85.3%) was distributed between the age 21 & 26 of 165 in patients, there were 109 cases (66%) of epididymitis, 90 cases (54.5%) of renal tuberculosis, 72 cases (43.6%) of prostatitis. 31 cases (18. 7%). of cystitis tuberculosis, and 2 cases (1.2%) seminal vesiculitis. In 26%, tuberculous diseases were present in the past history, the pleural & lung were most frequently invaded (23.6%). Of presenting symptoms, swelling of the epididymis was observed in 66.6%, frequency of urination (18.8%). In urine examination, W.B.C. 8/H.P.F. or more is observed in 67.2% R.B.C. 5/H.P.F, 5/HP, F, or more in 36.3%, albumin in 47.8% and tubercle bacilli in 36. 3%. Lateralization shows 52.2 % in the left kidney, 42.2% in the right kidney and 5.5% in the both kidney. There were 144 operative procedures including 68 nephrectomies and 76 epididiymectomies.