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Jung, Na, Yun, Song, Ryu, and Ryu: Disseminated Tuberculosis in a Patient with Chronic Renal Failure
Case Report
The Ewha Medical Journal

The Ewha Medical Journal 2013; 36(1): 67-71.

Published online: 25 March 2013

DOI: https://doi.org/10.12771/emj.2013.36.1.67

Disseminated Tuberculosis in a Patient with Chronic Renal Failure

Ka-Young Jung, Sun Kyung Na, Hye-Won Yun, Ha Eng Song, Jung-Hwa Ryu, Dong-Ryeol Ryu

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Dong-Ryeol Ryu, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-2507, Fax: 82-2-2655-2076, drryu@ewha.ac.kr

Received 22 October 2012       Accepted 30 October 2012

Copyright © 2013. Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.

Keywords: Chronic renal failure, Disseminated tuberculosis

Figures and Tables

Fig. 1
Initial radiologic findings. Chest X-ray shows pulmonary edema and cardiomegaly, while there is no evidence of pulmonary or miliary tuberculosis (A). Hepatomegaly and splenomegaly without abnormal enhancement in the liver is noted in abdominal computed tomography (B).
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Fig. 2
Histopathologic findings of the liver. There are scattered non-caseating granulomas with focus of multinucleated giant cell (A: H&E, ×200). The acid-fast bacilli are stained (B), and arrow indicates the bacilli (Ziehl-Neelsen stain, ×400).
emj-36-67-g002
Fig. 3
Chest radiographic images for the evaluation of orthopnea performed after 25 days of the start of anti-tuberculosis medication. Chest posterioranterior X-ray shows that focal consolidations are seen in right upper lung field (A). Active pulmonary tuberculosis is seen in right upper lobe (B), and right and left main bronchus is narrowing with enhanced wall thickening (C) in the chest computed tomography.
emj-36-67-g003
Table 1
Clinical course of the patient
emj-36-67-i001

*The day when liver biopsy was done. †The day when anti-tuberculosis medication was started. BT, body temperature.

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