An unusual association between renal tuberculosis and urothe
A 61-year-old patient, with no history of pulmonary tuberculosis, has been followed for non-invasive bladder cancer. Transurethral resection of bladder tumor has been realized followed by regular endoscopic follow-up, without BCG adjuvant therapy. After 2 years of follow-up, he developed hematuria without fever, cough, or any symptom evoking tuberculosis and physical examination was normal. Blood examination showed acute renal failure. Computed tomography revealed a bladder tumor with sheathing of the two ureteral orifices bilateral hydronephrosis, iliac, and left lumbar stenosis ureteral tissue formation taking the contrast, without other distant secondary localizations. The diagnosis of a locally advanced bladder tumor associated with a Left ureteral tumor was retained.

After nephrostomy in this right renal pelvis and normalization of renal function, a cystectomy with left nephroureterectomy and right cutaneous ureterostomy has been performed. The patient had an uneventful recovery and was discharged on the seventh postoperative day. Histology of the specimen found a ureteral localization of a urothelial carcinoma infiltrating the muscular (pT2) with many epithelioid, giant cellular granulomatosis, and caseous necrosis. Prostate, seminal vesicles, and ureteral recoup were intact. Based on the histological findings, we sent the nephrectomy specimen for bacteriological analysis. Tuberculosis-polymerase chain reaction (TB-PCR) testing confirmed the diagnosis of TB disease by confirming the presence of the Mycobacterium tuberculosis complex. The diagnosis of renal tuberculosis was retained. The urinary culture of tuberculosis was negative. The decision of the Tumor Board Meeting was to start an anti-tuberculosis treatment and a radiologic follow-up for urothelial cancer given the localized nature of the tumors and the completed character of the excision surgery. Bacteriological controls (direct examination and culture of Koch's bacillus) were negative after six months of anti-tuberculosis treatment. After six months of clinical and radiological check-ups, there were no functional complaints or signs of recurrence.

Source: https://www.sciencedirect.com/science/article/pii/S2214442022001255?dgcid=rss_sd_all
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