Spontaneous Nephrocutaneous Fistula With Tuberculous Autonephrectomy: A Case Report of a Delayed Diagnosis

Abstract

Introduction:Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected.Case Presentation:We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 51 × 60 mm area with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9 mm diameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB.Conclusions:Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.

Urogenital tuberculosis, the cause of ineffective antibacterial therapy for urinary tract infections

“…Correct diagnosis was established when imaging exams showed left ureteral stenosis with moderate hydronephrosis only; the patient underwent nephrectomy. 20 The analysis of clinical features of urinary TB in southwestern China has shown that the most common presenting symptoms were urinary irritation (61.1%) and lumbago (49.2%). High proportions of microscopic hematuria (63.2%) and microscopic proteinuria (45.6%) were also observed.…”

“…Correct diagnosis was established when imaging exams showed left ureteral stenosis with moderate hydronephrosis only; the patient underwent nephrectomy. 20…”

Obstructive uropathy as initial presentation of genitourinary tuberculosis and masquerading as a postsurgical complication

“…)4 Due to its insidious nature, patients typically present with symptoms after significant organ damage such as renal failure from ureteric obstruction. GU TB may also present with urolithiasis and as chronic pyelonephritis 8. However, there are no specific symptoms that are wholly suggestive of GU TB, and these conditions can result from a myriad of other causes.…”

“…Autonephrectomy,8 ureteric strictures,4 primary or secondary infertility10 and nephrocutaneous fistulae8 are some of the reported complications of GU TB. Our patient suffered multiple bacterial UTIs probably as a consequence of ureteric strictures with stenosis related to her TB disease.…”

A surfacing staghorn: Spontaneous expulsion of a large renal calculus from a nephrocutaneous fistula

“…The most frequently reported causes of spontaneous nephrocutaneous fistulae in the literature were staghorn calculi or multiple renal stones [10][11][12][13][14][15][16][17][18][19][20][21] associated with infection, particularly xanthogranulomatous pyelonephritis. 10,14,15,17 Other less common causes reported included ureteric stones, 22 renal tuberculosis 18,23 and renal replacement lipomatosis.…”