Extensive calcification in genitourinary tuberculosis misdiagnosed as ureteral calculi

Abstract

Ureteral calcification in genitourinary tuberculosis is extremely rare. A 36-year-old female presented with a diagnosis of right ureteral calculi. On further investigations, she was found to have a right nonfunctioning kidney with a suspected diagnosis of genitourinary tuberculosis which was confirmed on histopathology.

CASE

A 36-year-old female was admitted with right flank pain, fever, and burning micturition. She was referred to us with a diagnosis of right ureteric calculi, based on an ultrasound of the abdomen. No flank tenderness was present in the physical examination. A urine examination revealed sterile pyuria. An X-ray of the kidney-ureter-bladder region showed calcification in the region of the right kidney and the right ureter [Figure 1, arrows]. A tubercular-polymerase chain reaction of a urine specimen showed Mycobacterium tuberculosis. Antitubercular treatment was started, diethylenetriamine pentaacetate scan revealed a nonfunctioning right kidney. Robot-assisted right nephroureterectomy was done after patients' consent because of recurrent flank pain. The histopathology reported features of granulomatous inflammation of the kidney suggestive of tuberculosis.

Figure 1.

X-ray kidney-ureter-bladder showing calcifications in the kidney and ureter (arrows)

Genitourinary tuberculosis is commonly misdiagnosed given its nonspecific initial presentations. This case highlights the need for a high index of suspicion for diagnosing genitourinary tuberculosis. In the later stages of tuberculosis, calcification may predominate which destroys the kidney. The destructive effects of tubercular bacilli along with host immune defense mechanisms leading to granuloma formation further lead to calcium deposition.[1] Ureteral calcification in tuberculosis is rare and presents as intraluminal cast. The ureter is not dilated and gradually leads to loss of renal function.[2] The extensive calcification like in this index patient is very rare.

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