Abstract: PO1465
Acquired Bartter-Like Syndrome: An Unusual Presentation of Disseminated Tuberculosis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Tomacruz, Isabelle Dominique Villegas, Philippine General Hospital, Manila, Metro Manila, Philippines
- Villanueva, Anthony Russell, Philippine General Hospital, Manila, Metro Manila, Philippines
Introduction
Acquired Bartter-like syndrome is a rare renal tubular disorder described to occur in granulomatous disorders such as sarcoidosis; but, its propensity to occur in tuberculosis (TB) is less known.
Case Description
We report the case of a 33-year-old Filipino woman with a 2-week history of lower extremity weakness. She had normal blood pressure and mild weakness on manual muscle testing. Abdominal examination revealed an incidental left lower quadrant mass. Workup revealed hypokalemia with urinary potassium wasting, hypercalciuria, hypomagnesemia, hypochloremia, and metabolic alkalosis, all consistent with Bartter-like syndrome. Abdominal CT scan findings were suggestive of disseminated TB. Ultrasound guided aspiration of the psoas abscess and pigtail insertion were done. Abscess aerobic, anaerobic, and fungal cultures did not isolate any organisms. Histopathology did not reveal any malignant cells. Detection of acid fast bacilli by Ziehl-Neelsen stain and culture confirmed the diagnosis. The patient was started on anti-TB therapy and was maintained on spironolactone, potassium and magnesium supplementation upon discharge. On follow up, electrolyte abnormalities resolved after four months of anti-TB therapy.
Discussion
TB may be a rare acquired cause of Bartter-like syndrome. Management involves treatment of the underlying cause, spironolactone and electrolyte supplementation.
CT images.A:Coronal view shows a left psoas abscess (yellow arrow), & bowel wall thickening (blue arrows)B:Axial view shows abscesses in the liver & spleen C:Axial view with bone window shows osteolytic lesions with soft tissue components in the right aspect of the T10 vertebra
Blood & urine chemistry results.HD:Hospital Day