SHM Converge Scientific Abstract ePoster Gallery-Disseminated Miliary Tuberculosis: Some Unexpected Consequences

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A 43-year-old man from Guatemala with alcohol use, recent incarceration, and kidney stone history presented with abdominal pain and bloody diarrhea. Imaging revealed a psoas abscess, and further workup suggested disseminated tuberculosis, with bilateral miliary pulmonary nodules, bone marrow biopsy confirmation, and MRI brain showing multiple enhancing tuberculomas. He was also found to have significant kidney injury, bilateral non-obstructing stones, hydronephrosis, and severe metabolic acidosis.  <br /><br />Because of concern for renal and spinal TB, he was started on RIPE therapy and dexamethasone for CNS involvement. Urology initially considered stent or nephrostomy placement, but renal function improved with medical management, so intervention was deferred. He was discharged with public health follow-up.  <br /><br />Less than a month later, he returned with worsening acute kidney injury, creatinine 5.4 mg/dL, hypercalcemia, and was diagnosed with type 1 renal tubular acidosis secondary to renal tuberculosis. He received aggressive bicarbonate and potassium replacement. Nephrology again recommended nephrostomy to protect renal function, but a MAG-3 scan showed slow non-obstructive flow with preserved function in the left kidney and reduced function in the right. As his kidney function improved again, procedural intervention was deferred, and he was discharged with outpatient nephrology and urology follow-up.  <br /><br />This case highlights how disseminated miliary tuberculosis can cause severe multiorgan disease, including rare renal complications such as tubular acidosis and acute kidney injury. It emphasizes the need for thorough inpatient evaluation and multidisciplinary management, especially in patients from TB-endemic regions.

Asset Subtitle

Bryan Chan

Meta Tag

Author List Achraf Mansour, Bryan Chan, Christopher Dagher

Category Clinical Vignettes

Concept Disseminated Tuberculosis

Concept Renal involvement

Concept Extrapulmonary Involvement

Concept Acute Kidney Injury

Concept Diagnostic Imaging

Distinguished Non-Finalist

Presenter Organization Huntington Health

Presenting Author Bryan Chan

Track Adult

Keywords

disseminated tuberculosis

miliary pulmonary nodules

psoas abscess

tuberculomas

acute kidney injury

renal tuberculosis

type 1 renal tubular acidosis

hypercalcemia

RIPE therapy

multidisciplinary management

Disseminated Tuberculosis

Renal involvement

Extrapulmonary Involvement

Acute Kidney Injury

Diagnostic Imaging