A Female Patient With Clinical Symptoms as Recurrent Urinary Tract Infection Caused By Urinary Tract Tuberculosis

CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE JOURNAL SURABAYA , VOLUME 01 NO.1 JANUARY 2020 16 CASE REPORT A Female Patient With Clinical Symptoms as Recurrent Urinary Tract Infection Caused by Urinary Tract Tuberculosis Rastita Widyasari1, Artaria Tjempakasari2*, Chandra Irwanadi Mohani2 Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital Surabaya, Indonesia. 2 Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital Surabaya, Indonesia. 1 ABSTRACT Background: Urinary tract tuberculosis (TB) is one type of extrapulmonary TB. The prevalence in developed countries is around 15-20% of all cases of extrapulmonary TB. The insidious onset and non-specific constitutional symptoms of urinary tuberculosis often lead to delayed diagnosis and rapid progression to a non-functioning kidney. The only way to limit renal function loss and destruction is by early diagnosis and therapy. Case: 34-year-old woman, came with complaints of urinary pain accompanied by right flank pain 10 months prior. Patient also had complaint of weight loss but ignoring complaints of night sweats. Patient repeatedly diagnosed as a urinary tract infection and received many kinds of antibiotic therapy but her complaints were not getting better. Urine production was about 1700 cc/24 hours. From general physical examination, there was a lack of nutritional status with BMI 17.1 kg/m2. Vesicular lung sound without rhonchi heard in both lung fields. From the urinalysis examination there were pyuria and haematuria without bacteriuri. Laboratory examination showed value of BUN was 17 mg/dl and creatinine 0.9 mg/dl. From aerob urine culture we found sterile urine. But we found positive result of Mycobacterium tuberculosis (MTB) urine cultures which was sensitive to isoniazid, rifampicin, pyrazinamide, and ethambutol. Abdominal ultrasound showed severe ecstasis of right pelviocalyceal system without stones,mass, nor cyst. We had additional data from intravenous pyelogram (IVP) which showed a nonvisualized dextra pelviocalyceal system and delayed bladder emptying function at 120th minutes. From computed tomography stonographic, we found severe right hydronephrosis, proximal to distal right hydroureter, and thickening of bladder wall (± 1.61 cm) on the right anterolateral side. To find out the cause of thickening of bladder wall, we did bladder biopsy which showed the mononuclear inflammatory cell stroma. Patients were diagnosed with urinary tract TB and received category 1 of oral anti tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamid, and Ethambutol) for 12 months and underwent right DJ stent implantation to manage the ectasys. Conclusion : Urinary tract TB often showed unspecified complaints and can be suggested as recurrent urinary tract infections. Early diagnosis and optimal management were needed to prevent anatomical and functional complications. Correspondence: Artaria Tjempakasari E-mail: Article history: •Received 30 December 2019 •Received in revised form 09 January 2020 •Accepted 27 January 2020 INTRODUCTION Urinary tract infection (UTI) is an inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria. In while, a recurrent UTI is infection of urinary tract that occurs after documented with successful resolution of an antecedent infection (Schaeffer et al., 2016). Chronic nonspecific urinary infections may be confused with genitourinary tuberculosis (GUTB). Absence of response to usual antibiotics should raise suspicion of urinary TB (Figueiredo and Lucon, 2008, Visweswaran and Suresh., 2000). Tuberculosis (TB) is a major global health problem. According to a recent report by the World Health Organization (WHO), there were almost 8.6 million new cases of active TB worldwide. WHO estimates that one third of the world’s population is infected with Mycobacterium tuberculosis in its latent form (WHO, Available at https://e-journal.unair.ac.id/CIMRJ 2013). Extrapulmonary sites account for 10% of TB cases. The frequency of genitourinary tuberculosis (GUTB) in developed countries approaches 15% to 20%. GUTB also has been found in about 5% of active TB cases in the non– HIV-infected population. In developed countries, GUTB is the second most common form of extrapulmonary TB after peripheral lymphadenopathy (Figueiredo and Lucon, 2008, Visweswaran and Suresh., 2000, Daher Ede et al., 2013, Rai et al., 2009). Symptoms and signs of GUTB are commonly nonspecific. Patients are often treated for other bacterial infections (sometimes repeatedly) or are evaluated for possible malignancy before GUTB is entertained (Figueiredo and Lucon, 2008). GUTB can lead to irreversible tissue damage with serious consequences such as renal failure, making it critical for clinicians to consider TB in the differential diagnosis of genitourinary disorders. CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE JOURNAL SURABAYA , VOLUME 01 NO.1 JANUARY 2020 TB can mimic many other diseases and complicate the correct diagnosis and treatment of infected patients (Chang et al., 2016). CASE REPORT A female, Mrs. T, 34 y.o, work as factory labor, married, a moslem, live in Krajan, Ngreco, Pacitan came to Nephrology Outpatient Clinic Dr.Soetomo General Hospital with chief complaint of pain during urination. Patient was referred from Pacitan public hospital with diagnosis of recurrent urinary tract infection + chronic cystitis. Patient felt pain during urination since 10 months prior coming to Dr.Soetomo General Hospital Outpatient Clinic eventough received many kind of medical therapies. Pain during urination was described as excessive sensation to urinate and felt discomfort during urinate. Urine flew slowly and ended with dissatisfied sensation. There were no complaints of leucorrhea, cloudy urine, pelvic pain, and changes in menstrual cycle. Patient did not complaining fever nor appetite decreasing. Nevertheless, patient complained weight loss of 46 kgs to 41 kgs (5kgs) in 10 months. Her urine output was about 1700 cc/24 hours. There were no history of bladder stones, trauma, tumour, or previous cathether using. There were no history of diabetes, chronic cough, and anti-tuberculosis drugs. There were no history of free-sex habitual, tattoo, nor drugs consumption. Her husband did not feel the same complaint. Patient have 2 children and there was no history of miscarriage. From family history taking, there were no history of similar complaints, tumour, nor chronic cough. From medical history, patient was diagnosed as urinary tract infection by general practitioners in Pacitan 10 months ago and got antibiotic. Patient felt better after treatment, but the same complaint occured again 2 weeks later. Patient was given another kind of antibiotic, but a month later, patient felt the same complaint in more severe pain than before and acco (...truncated)