A ccording to the World Health Organization, the annual tuberculosis (TB) burden in India was 2.2 million in 2012; this figure constitutes one quarter of global TB cases per year.1 Genitourinary TB is a common form of extrapulmonary TB, accounting for 27% (range: 14-41%) of all cases of extrapulmonary TB in developed countries.2 Usually, genitourinary TB is a complication in 3-4% of pulmonary TB cases.3 Active genitourinary TB generally occurs between five and 15 years after a primary pulmonary infection with Mycobacterium tuberculosis. 4 Despite its status as the most common form of genitourinary TB, renal TB is very rare in the paediatric population. 5Genitourinary TB mostly presents with irritative voiding symptoms, haematuria and flank pain. Presentation as a mass lesion is extremely rare and few cases have been published in the literature to date. [7][8][9][10] This report describes a two-year-old child who presented with a renal mass and was diagnosed with renal TB via a post-nephroureterectomy histopathological examination. Case ReportA two-year-old girl presented to a private health clinic in Kolkata, India, with non-specific abdominal pain of three months' duration. As she did not improve with symptomatic management and anthelmintic therapy, she was referred to the Nil Ratan Sircar Medical College, Kolkata, India, in June 2014 for further evaluation. There was no history of fever, vomiting, altered bowel habits, abdominal distension or changes in urinary frequency or colour over the preceding three months. In addition, no appetite or weight loss had been observed by the parents. The child Genitourinary tuberculosis usually occurs in young adults and the middle-aged and is very uncommon in the paediatric population. It generally presents with haematuria, pyuria, irritative voiding symptoms and flank pain; presentation as a renal mass is highly unusual. We report a two-year-old girl who was referred to the Nil Ratan Sircar Medical College, Kolkata, India, in June 2014 with abdominal pain. Subsequent radiological investigations revealed a left renal hypoechoic mass lesion. A left nephroureterectomy was performed on suspicion of a Wilms' tumour. Histopathology indicated an epithelioid granuloma with lymphocytic infiltration, suggestive of a tubercular aetiology. A Mantoux tuberculin skin test was positive; however, there was no evidence of tuberculosis detected elsewhere in the body and the source of the infection could not be identified. A diagnosis of renal tuberculosis was made and the child was treated with antitubercular drugs. The patient was asymptomatic at a six-month follow-up.

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Nontubercular mycobacteria (NTM) are widely distributed in the environment. Though Mycobacterium aviumintracellulare complex (MAC) is the most common NTM species causing disease in humans, new species of NTM are being isolated due to improved methods of detection and increased physician awareness. One of these rare form of NTM is Mycobacterium intermedium. Although the disease was irst reported in 1993, there are only very few cases have been reported so far. Here we are presenting a case of 40-year-old nonsmoker, nondiabetic, non-immunosuppressed person who initially sought medical attention for high grade fever, cough with mucoid expectoration, and breathlessness for 2 weeks and later diagnosed to be a case of M. intermedium.

aspect of right side of lower chest and lumber region. The patient had intermittent low-grade fever, loss of appetite, and generalized weakness. There was no history of cough, expectoration, hemoptysis, or breathlessness. He had sputum-positive pulmonary TB 1 year ago and for that he had been treated with isoniazid, rifampicin, pyrazinamide, and ethambutol for initial 2 months and with isoniazid and rifampicin for next 4 months. The results of follow-up sputum acid-fast bacillus (AFB) strain examination at the end of second, fourth and sixth month were negative, and the patient was declared cured at end of 6-month therapy. He had no history of any comorbidity or addiction. On general examination, it was found that there was mild pallor and body temperature was raised (100.4 °F). Body weight was 50 kg. There was a huge fluctuant nontender, nonpulsatile swelling with ill-defined margin in right paravertebral region extending from infrascapular area up to right loin [Figure 1]. Surface temperature of the swelling was not raised compared to the opposite side of body. The result of transilluminancy test was negative. The findings of examination of respiratory, neurological, and other systems were normal. Investigation revealed hemoglobin levels to be 10.4Gm%; total leukocytic count, 11200/mm 3 (N64%, L24%, E4%, M8%, BO%); ESR, 110 mm in first hour. Fasting blood glucose was 98 mg/dl. The result of Mantoux test was positive (14 mm × 12 mm) but that for sputum examination was negative for AFB. He was HIV negative. PA chest X-ray revealed few fibrotic area occupying right upper and left lower zone, but X-ray of dorsal spine [Figure 2] revealed fusiform swelling extending from eighth thoracic vertebra up to 12th thoracic Although prevalence of drug-resistant pulmonary tuberculosis is increasing globally, only a few cases of drug-resistant extrapulmonary tuberculosis have been reported globally so far. Tubercular cold abscess is a form of extrapulmonary tuberculosis that is responsible for a significant morbidity and mortality. It is more challenging to the patient and clinician if the same occur due to multidrug-resistant strain of Mycobacterium. We report a case of multidrug-resistant tubercular cold abscess that is extremely rare in the literature.