Disseminated tuberculosis following the placement of ureteral stents: a case repot

Abstract

BackgroundMiliary tuberculosis occurs as a result of hematogenous dissemination of Mycobacerium tuberculosis. This can occur due to progressive primary infection, reactivation of latent focus with subsequent spread, or rarely via iatrogenic origin.Case presentationThis is a case of 21 year-old woman presented with hydronephrosis and hematuria due to unrecognized renal tuberculosis. She underwent bilateral ureteral stent placement which lead to dissemination of the Mycobateria through the blood causing pulmonary tuberculosis and multiple tuberculous abscesses in the paraspinous muscles, pleural space and skin.ConclusionDisseminated tuberculosis due to Mycobacteremia after surgical intervention is a rare complication. Mycobacteria should be considered among other more common microorganisms that can cause post operative bacteremia.

A Rare Cause of Acute Respiratory Distress Syndrome

“…None of the studies have shown surgery as a risk factor for development of ARDS. However surgery is known to disseminate unrecognized tuberculosis [9]. Thus, D & C possibly led to the development of ARDS in our case with existing 'cryptic miliary TB', which was missed during preoperative evaluation.…”

Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup

“…These include human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), and other causes of immunosuppression such as use of biologicals and immunosuppressive drugs for the treatment of various medical disorders, increasing prevalence of organ transplantation, alcoholism, chronic liver disease, chronic hemodialysis, diabetes mellitus, malignancies, and silicosis. [ 1 2 3 4 5 6 7 ]…”

“…A few cases have been published, describing dissemination of TB after instrumentations of the renal system. [ 2 10 11 12 ] Other reports have described the disease after surgical intervention in a tuberculous epididymitis,[ 13 ] intraocular TB,[ 14 ] and following intravesical Bacillus Calmette–Guérin (BCG) immunotherapy for transitional cell cancer of the bladder. [ 15 ] Dissemination of TB was also described in the transplantation of organs with unrecognized TB such as infected cadaveric kidney[ 16 ] and homograft valve.…”

“…The clinical presentation of disseminated TB is highly variable and usually includes subacute or chronic constitutional symptoms (such as fever, weight loss, and night sweats) as well as clinical pictures ranging from anorexia and pyrexia of unknown origin to even multiorgan failure that reflects the underlying organ involved. [ 1 2 3 4 21 ]…”

“…Disseminated tuberculosis (TB) is defined as the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis , occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread,[ 1 ] or rarely through iatrogenic origin. [ 2 ] Nowadays, the term miliary TB also refers to progressive and widely spread forms of TB. It entails a hematogenous spread of the disease to several organs, even if the classical pathologic or radiologic findings are absent.…”