Genito-Urinary Tuberculosis – A Great Mimicker and Its Atypical Manifestations: An Interesting Case Series

Case Report

Austin J Urol. 2017; 4(1): 1051.

Genito-Urinary Tuberculosis – A Great Mimicker and Its Atypical Manifestations: An Interesting Case Series

Krishnamoorthy S*, Gopalakrishnan G and Kekre NS

1Department of Urology, Sri Ramachandra Medical College & RI, India

2Department of Urology, Vedanayagam hospital, India

3Department of Urology, Christian Medical College, India

*Corresponding author: Krishnamoorthy S, Department of Urology, Sri Ramachandra Medical College & RI, India

Received: October 04, 2016; Accepted: December 28, 2016; Published: January 04, 2017


Tuberculosis continues to be a major health problem in the developing world. Renal tuberculosis is the most common site of extra – pulmonary tuberculosis. It comprises 20% of all extra pulmonary tuberculosis. The accurate incidence and prevalence of Genito Urinary Tuberculosis (GUTB) is difficult to be figured out because a very large varieties of atypical presentations. It is often called as a “Great Mimicker” because of the variety of other conditions that it might mimic. A vast majority of patients remain asymptomatic and present in late stages as the disease is not thought of in these asymptomatic patients. Moreover the urine can become sterilized relatively rapidly after the initiation of chemotherapy, further adding on to the diagnostic difficulties.

In this manuscript, we report a series of GUTB cases that presented in an atypical manner, causing diagnostic and management dilemma. The purpose of this manuscript is to highlight the variety of atypical manifestations of GUTB and also to stress on the need for a high index of clinical suspicion in identifying such cases at an earlier stage in order to prevent the disease from progressing to non- salvageable state.

Keywords: Tuberculosis; Genitourinary tuberculosis; Kidney; Anti tuberculosis therapy; Nephrectomy


Tuberculosis is a major public health problem in India. Every year 1.8 million new cases of TB are diagnosed of which 0.8 million are smear positive [1]. The emergence of drug resistance strains adds to the complexity of the situation in our country. The urinary tract is one of the commonest sites of extra-pulmonary tuberculosis [2]. While in the majority the symptoms are cast- iron, in a not insignificant number, the presentation is atypical. This naturally results in delayed diagnosis. In this article we wish to highlight some of the atypical presentations of genito-urinary tuberculosis and focus on the need for constant vigil in establishing the diagnosis.

Case 1

A 35 year old female with primary infertility was evaluated for low grade fever and vague abdominal discomfort. She also had a decrease in appetite and a loss of weight. On evaluation, she was diagnosed to have abdominal tuberculosis with thickened omentum. Omental biopsy confirmed her disease. She did not have any loin pain or obstructive or irritative urinary complaints. As the ultrasound also showed right hydronephrosis (Figure 1A), she was further evaluated. Her serum Creatinine was 1.0 mg%. Her urine AFB was negative. Intra-venous Urography suggested non-visualized right kidney (Figure 1B). Isotope Renogram confirmed a very poorly functioning right kidney (Figure 1C). She was started on Anti-Tuberculous Therapy (ATT) and subsequently underwent right Nephrectomy. Prior to Nephrectomy, she had a cystoscopy and retrograde ureterogram. The bladder was of good capacity. The ureteric orifices and bladder surface were normal. Retro-grade study demonstrated a complete cutoff at the level of right lower ureter, about 2 centimeters (cm) proximal to the ureteric orifice. The kidney, on cut-section was found to be grossly hydronephrotic with multiple cavitations. The histopathology report was suggestive of tuberculosis pyelonephritis. Following ATT and Nephrectomy, her constitutional symptoms improved significantly.