Abstract: SA-PO0049
Lessons from a Case of Relentless Genitourinary Tuberculosis
Session Information
- AKI: Novel Patient Populations and Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Tahir, Muhammad Khalid, New York Medical College - Metropolitan Hospital, New York, New York, United States
- McManus, Kelsey, New York Medical College - Metropolitan Hospital, New York, New York, United States
- Ahmad, Saadiyah, Frontier Medical and Dental College, Abbottabad, N.W.F.P, Pakistan
- Velasquez, Maria Rosa, New York Medical College - Metropolitan Hospital, New York, New York, United States
Introduction
In the United States, genitourinary tuberculosis (GUTB) accounts for 4.6% of extrapulmonary tuberculosis (TB) cases. Though rare, it can cause serious complications, particularly fibrotic strictures that can progress despite microbiologic response. We present a case of progressive GUTB complicated by ureteral obstruction and renal failure during standard therapy, highlighting diagnostic and management challenges of this underrecognized TB manifestation.
Case Description
A 38-year-old man with recurrent left scrotal abscesses since 2021 was diagnosed with tuberculous epididymitis requiring left orchiectomy in August 2024. He also tested positive for pulmonary TB and was started on standard RIPE anti-TB therapy (ATT), later continued with rifampin and isoniazid. Pulmonary disease cleared by October 2024. Urine PCR and testicular acid-fast bacilli (AFB) cultures were positive for Mycobacterium tuberculosis (MTB). Retrospective CTs from 2021–2022 showed evolving renal and bladder abnormalities, initially unrecognized as TB-related. Six months into treatment, he developed dysuria, urgency, and AKI (creatinine 6.7 mg/dL). Imaging revealed bilateral adrenal thickening, moderate hydronephrosis, and hydroureter. The right ureter could not be cannulated due to difficult access; however, renal function improved after placement of a left ureteral J stent. MTB was again positive in urine PCR, but serial AFB stain and cultures were negative. The patient continued ATT with plan for right nephrostomy.
Discussion
Renal function recovery after decompression supports obstructive nephropathy from GUTB-related ureteral scarring rather than rifampin-induced interstitial nephritis. Reports suggest 5–15% of GUTB patients develop new or progressive strictures within the first 3–6 months of treatment due to fibrosis and not necessarily as part of uncontrolled infection. In this case, drug sensitivity and adherence were confirmed. Urine PCR remained positive with negative AFB cultures, suggesting residual DNA rather than viable organisms. PCR can persist for months after clearance, especially in extrapulmonary TB, and should not imply treatment failure.
Conclusion: This case underscores the need for integrating clinical, imaging, and microbiologic data when managing GUTB. Longitudinal follow-up is essential to detect evolving structural complications and guide timely intervention.