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Case Report

Disseminated Tuberculosis in a Patient with Chronic Renal Failure

Ka-Young Jung, Sun Kyung Na, Hye-Won Yun, Ha Eng Song, Jung-Hwa Ryu, Dong-Ryeol Ryu
The Ewha Medical Journal 2013;36(1):67-71. Published online: March 25, 2013

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Dong-Ryeol Ryu, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-2507, Fax: 82-2-2655-2076, drryu@ewha.ac.kr
• Received: October 22, 2012   • Accepted: October 30, 2012

Copyright © 2013. Ewha Womans University School of Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.
  • Keywords: Chronic renal failure; Disseminated tuberculosis
  • 1. World Health OrganizationGlobal tuberculosis control report 2012 2012;Geneva, World Health Organization.
  • 2. Korea Center for Disease Control and PreventionKorean Institute of TuberculosisAnnual report on the notified tuberculosis patients in Korea 2011;Seoul, Korean Institute of Tuberculosis.
  • 3. Hussein MM, Mooij JM, Roujouleh H. Tuberculosis and chronicrenal disease. Semin Dial 2003;16:38-44.
  • 4. Choi BK, Lee HS, Hwang IH, Shin KH, Choi MK, Choi BG, et al. Comparative analysis of the clinical features and prognosis of extrapulmonary tuberculosis according to the renal function. Korean J Med 2010;79:387-393.
  • 5. Yoon SY, Choi SR, Kang EW, Goo YS, Kim BS, Youn HJ, et al. Clinical features of tuberculosis in dialysis patients. Korean J Nephrol 2003;22:73-79.
  • 6. ESRD Registry Committee, Korean Society of NephrologyCurrent renal replacement therapy in Korea-Insan memorial dialysis registry 2008. Korean J Nephrol 2009;28:S498-S510.
  • 7. Korea National Statistical OfficeDeaths and death rate by cause 2008;Daejeon, Korea National Statistical Office.
  • 8. Chia S, Karim M, Elwood RK, FitzGerald JM. Risk of tuberculosis in dialysis patients: a population based study. Int J Tuberc Lung Dis 1998;2:989-991.
  • 9. Descamps-Latscha B, Herbelin A, Nguyen AT, Jungers P, Chatenoud L. Dysregulation of the immune system in chronic uremicand hemodialysed patients. Presse Med 1995;24:405-410.
  • 10. Vanholder R, Ringoir S. Polymorphonuclear cell function and infection in dialysis. Kidney Int Suppl 1992;38:S91-S95.
  • 11. Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 1999;55:1081-1090.
  • 12. Moon GH, Song JH, Lee SW, Lee KJ, Park HS, Kim MJ. Hepatic tuberculous abscess and miliary tuberculosis in a gemodialysis patient. Korean J Nephrol 2001;20:332-336.
  • 13. US Department of Health and Human ServicesReported tuberculosis in the United States 2002;Atlanta, GA, Centers for Disease Control and Prevention.
  • 14. Klatskin G. Schiff L. Hepatitis associated with systemic infections. Disease of the liver 1975;Philadelphia, J. B. Lippincott. 711.
  • 15. Godwin JE, Coleman AA, Sahn SA. Miliary tuberculosis presenting as hepatic and renal failure. Chest 1991;99:752-754.
  • 16. Hussain W, Mutimer D, Harrison R, Hubscher S, Neuberger J. Fulminant hepatic failure caused by tuberculosis. Gut 1995;36:792-794.
  • 17. Sharma SK, Shamim SQ, Bannerjee CK, Sharma BK. Disseminated tuberculosis presenting as massive hepatosplenomegaly and hepatic failure. Case report. Am J Gastroenterol 1981;76:153-156.
  • 18. Essop AR, Posen JA, Hodkinson JH, Segal I. Tuberculosis hepatitis: a clinical review of 96 cases. Q J Med 1984;53:465-477.
  • 19. Kang GH, Kim YI, Kim CW. Confirmation of tuberculosis hepatitis using polymerase chain reaction. Korean J Gastroenterol 1997;30:415-419.
  • 20. Wilfredo T, Rodolfo M, Klaus-Dieter K, Ari K. Friedman LN. Extrapulmonary tuberculosis. Tuberculosis, current concepts and treatment 2001;2nd ed. Boca Raton, CRC Press. 139-190.
  • 21. Wang JY, Hsueh PR, Wang SK, Jan IS, Lee LN, Liaw YS, et al. Disseminated tuberculosis: a 10-year experience in a medical center. Medicine (Baltimore) 2007;86:39-46.
Fig. 1
Initial radiologic findings. Chest X-ray shows pulmonary edema and cardiomegaly, while there is no evidence of pulmonary or miliary tuberculosis (A). Hepatomegaly and splenomegaly without abnormal enhancement in the liver is noted in abdominal computed tomography (B).
emj-36-67-g001.jpg
Fig. 2
Histopathologic findings of the liver. There are scattered non-caseating granulomas with focus of multinucleated giant cell (A: H&E, ×200). The acid-fast bacilli are stained (B), and arrow indicates the bacilli (Ziehl-Neelsen stain, ×400).
emj-36-67-g002.jpg
Fig. 3
Chest radiographic images for the evaluation of orthopnea performed after 25 days of the start of anti-tuberculosis medication. Chest posterioranterior X-ray shows that focal consolidations are seen in right upper lung field (A). Active pulmonary tuberculosis is seen in right upper lobe (B), and right and left main bronchus is narrowing with enhanced wall thickening (C) in the chest computed tomography.
emj-36-67-g003.jpg
Table 1
Clinical course of the patient

*The day when liver biopsy was done. †The day when anti-tuberculosis medication was started. BT, body temperature.

emj-36-67-i001.jpg

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      Disseminated Tuberculosis in a Patient with Chronic Renal Failure
      Ewha Med J. 2013;36(1):67-71.   Published online March 25, 2013
      DOI: https://doi.org/10.12771/emj.2013.36.1.67
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      Disseminated Tuberculosis in a Patient with Chronic Renal Failure
      Ewha Med J. 2013;36(1):67-71.   Published online March 25, 2013
      DOI: https://doi.org/10.12771/emj.2013.36.1.67
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      Disseminated Tuberculosis in a Patient with Chronic Renal Failure
      Image Image Image
      Fig. 1 Initial radiologic findings. Chest X-ray shows pulmonary edema and cardiomegaly, while there is no evidence of pulmonary or miliary tuberculosis (A). Hepatomegaly and splenomegaly without abnormal enhancement in the liver is noted in abdominal computed tomography (B).
      Fig. 2 Histopathologic findings of the liver. There are scattered non-caseating granulomas with focus of multinucleated giant cell (A: H&E, ×200). The acid-fast bacilli are stained (B), and arrow indicates the bacilli (Ziehl-Neelsen stain, ×400).
      Fig. 3 Chest radiographic images for the evaluation of orthopnea performed after 25 days of the start of anti-tuberculosis medication. Chest posterioranterior X-ray shows that focal consolidations are seen in right upper lung field (A). Active pulmonary tuberculosis is seen in right upper lobe (B), and right and left main bronchus is narrowing with enhanced wall thickening (C) in the chest computed tomography.

      Fig. 1

      Fig. 2

      Fig. 3

      Disseminated Tuberculosis in a Patient with Chronic Renal Failure

      Clinical course of the patient

      *The day when liver biopsy was done. †The day when anti-tuberculosis medication was started. BT, body temperature.
      Table 1 Clinical course of the patient

      *The day when liver biopsy was done. †The day when anti-tuberculosis medication was started. BT, body temperature.

      Table 1

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