Renal Tuberculosis Presenting as a Mass Lesion in a Two-year-old Girl: Report of a rare case

Abstract

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.

Abdominal Tuberculosis in Children—Imaging and Intervention

“…TB of the renal tract is said to occur between 5 and 15 years after a primary pulmonary infection with M. tuberculosis and is very rare in the pediatric population. 21 Although the mode of spread is primarily hematogenous, the disease is often more severe in one kidney. 19 Infection results in papillary destruction and cavitation of the kidneys.…”

“…Solitary granulomas may mimic renal neoplasms. 19,21 CT is helpful in showing hypodense parenchymal granulomas and miliary lesions and delayed images can demonstrate collecting system involvement, but this involves a significant radiation burden and is not recommended in children. MRI, through the use of MR urography elegantly shows the findings of TB previously described on intravenous urography, namely, pericalyceal cavities, strictures at the infundibula, pelviureteric, and vesicoureteric junctions, and caseous necrosis in granulomas 23 (►Fig.…”

Incidental diagnosis of renal tuberculosis in an adolescent submitted to videolaparoscopic nefrectomy

“…In cases where the lesion involves the renal parenchyma or where the kidney remains non-functioning despite adequate drainage for an obstructing lesion, nephrectomy ensures removal of the infective pathology and decreases chances of resurgence of the disease [20,21].…”

Multidetector computed tomography has replaced conventional intravenous excretory urography in imaging of the kidneys: A scoping review of multidetector computed tomography findings in renal tuberculosis

“…Tuberculosis is usually caused by infection with Mycobacterium tuberculosis ; however, there are other described mycobacteria. 4,5,6,7,8,9,10,11 TB can affect any system in the body and pulmonary TB is the most common form. 2,5,12,13 Extrapulmonary TB is uncommon; however, co-infection with HIV or other immunocompromised states increases susceptibility.…”

“…10,11,16 Renal TB is particularly rare in children because of the long latent period and it is even rarer in children below 5 years of age. 8,9,11,18,23,27 Renal TB has been reported to be common in young adults with a male predominance. 5,9,11,17,27…”