Miliary tuberculosis, with renal and genitourinary disemination; Case Report

Abstract

A 48-year-old male patient, a low-income farmer with no previous comorbidities, presented constitutional symptoms, weight loss, fever, and low back pain radiating to both sides of the abdominal region, with poor specificity, one month of evolution; Accompanied by dysuria and oliguria, and denies respiratory symptoms. Physical examination is chronically ill, in poor nutritional status, without deterioration of consciousness, no cervical or inguinal lymph nodes are present; Without presence of pulmonary signs, with mild pain with the fist bilateral percussion, in the genital area, a regular border mass, movable on the upper pole of the right testicle, is identified. In the hematological examination with the presence of hypochromic microcytic anemia and mild thrombocytopenia, in arterial gases metabolic acidosis with elevated anion Gap, in addition to hyperazoemia and hyperkalemia in blood chemistry refractory to treatment, which is why he underwent acute hemodialysis. When evaluating the chest X-ray, a diffuse micronodular pattern was observed; smear microscopy searching for micobacterium was not performed due to lack of expectoration and gastric lavage; renal and urinary tract ultrasonography showed nephromegaly and the presence of a heterogeneous mass of granulomatous aspect in the right testicle; For which a thoracoabdominal tomography was requested, where a multiple micronodular pattern was observed at the pulmonary level, with renal, lymph node and testicular involvement, serial urinary sediment were requested with positive results for Ziehl Neelsen stain; With which antifimic therapy is initiated.