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| LETTER TO EDITOR |
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| Year : 2012 | Volume
: 15
| Issue : 4 | Page : 498-499 |
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Unusual presentation of renal tuberculosis in type 2 diabetes
KVS Hari Kumar1, I Pandey2, K Singh3, D Mukherjee3
1 Department of Endocrinology, Command Hospital, Lucknow- 226 002, Uttar Pradesh, India
2 Department of Respiratory Medicine, Command Hospital, Lucknow- 226 002, Uttar Pradesh, India
3 Department of Nephrology, Command Hospital, Lucknow- 226 002, Uttar Pradesh, India
| Date of Web Publication | 12-Dec-2012 |
Correspondence Address:
KVS Hari Kumar
Department of Endocrinology, Command Hospital, Lucknow- 226 002, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1119-3077.104540
How to cite this article:
Kumar KH, Pandey I, Singh K, Mukherjee D. Unusual presentation of renal tuberculosis in type 2 diabetes. Niger J Clin Pract 2012;15:498-9 |
Sir,
A 62-year-old man, known case of type 2 diabetes mellitus (T2DM) for 12 years, presented with prolonged fever, breathlessness, and cough with mucoid expectoration of 2 months' duration. He also gave history of occasional hemoptysis and hematuria. He denied any other urinary symptoms like loin pain and oliguria. He was admitted to a peripheral hospital earlier where a pleurocentesis was done and straw-colored fluid was removed. Prior to presentation, he was using three oral hypoglycemic agents with poor glycemic control. Clinical examination revealed poor oral hygiene in a thinly built and malnourished (BMI 18.6 kg/m 2 ) patient with tachypnea and tachycardia. Chest examination revealed decreased movements of left hemithorax with diminished breath sounds and stony dull note. Renal angles were tender. Rest of the systemic examination was normal. Investigations revealed polymorphonuclear leukocytosis and left hydropneumothorax [Figure 1]. Computed tomography scan of abdomen revealed bilateral hypodense areas in both the kidneys with surrounding collection [Figure 2]. The patient was diagnosed as a case of disseminated tuberculosis with bilateral perinephric and intrarenal abscesses in type 2 diabetes. Pleurocentesis revealed lymphocytic predominant exudative fluid with elevated ADA (adenosine deaminase). A Ziehl-Neelsen stain on pleural fluid showed acid-fast bacilli, confirming the diagnosis of disseminated tuberculosis. He was treated with four-drug antituberculous therapy (Rifampicin, Isoniazid, Pyrizinamide, and Ethambutol) along with insulin, chest tube drainage, and other supportive measures. Perinephric abscesses were not drained in view of size <5 cm and good response to antituberculous therapy. Patient showed marked improvement with gradual resolution of the perinephric abscesses and gained 4 kg of weight during last review. | Figure 2 : Computed tomography scan of abdomen showing bilateral perinephric abscesses
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Tuberculosis remains a major threat in developing countries and prevalence of T2DM is increasing rapidly in these countries simultaneously. [1] This deadly combination of communicable and non-communicable disease poses a major public health challenge. T2DM accounts for about 15-20% of tuberculosis infection in India. [2] Tuberculosis in diabetes patients has rapid progression, delayed resolution, and frequent reactivation.
Diabetes remains the commonest comorbidity factor in developing renal abscess. [3] The frequently isolated pathogens are gram negative bacteria like E. coli or K. pneumoniae. Our patient had disseminated tuberculosis with M. tuberculosis as the underlying etiology. Surgical drainage is indicated only if size of the abscess is more than 5 cm. [4] Renal tuberculosis manifests commonly as sterile pyuria, and presentation as bilateral perinephric abscesses with intrarenal abscess is very rare as observed in our patient.
 References | |  |
| 1. | Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health 2007;7:234. 
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| 2. | Shetty N, Shemko M, Vaz M, D'souza G. An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study. Int J Tuberc Lung Dis 2006;10:80-6.
[PUBMED] |
| 3. | Lin HS, Ye JJ, Huang TY, Huang PY, Wu TS, Lee MH. Characteristics and factors influencing treatment outcome of renal and perinephric abscess--a 5-year experience at a tertiary teaching hospital in Taiwan. J Microbiol Immunol Infect 2008;41:342-50.
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| 4. | Lee SH, Jung HJ, Mah SY, Chung BH. Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage. Yonsei Med J 2010;51:569-73.
[PUBMED] |
[Figure 1], [Figure 2]
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