Abstract Ref Number = APCP1213
STERILE PYURIA IN CHILDREN WITH RENAL TUBERCULOSIS, A CASE REPORT
Muhammad Ramdhani Yassien,Partini Pudjiastuti Trihono,Wahyuni Indawati
Universitas Indonesia Department of Pediatric, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo General Hospital, Jakarta
Background : Suspicion of genitourinary tuberculosis (TB) must be considered if the patient has symptoms of recurrent UTI or haematuria associated with sterile pyuria. Sterile pyuria is defined as positive urine dipstick for leucocytes in the absence of haematuria or nitrites, with subsequent mid-stream urine showing no bacterial growth. In developing countries, sterile pyuria can be caused by partially treated UTI, genitourinary TB or fungal infection. Renal tuberculosis in children is a rarely documented nor reported.
Case Presentation Summary : A 5 year-old-girl was admitted with prolonged fever and recurrent UTI. Patient has been reassessed for bacterial infection by means of aerobic and anaerobic cultures with negative results. Other cause was excluded, we investigate for the possibility of TB infection. The history of household contact TB was negative proved by neither chest X-ray nor sputum acid fast bacilli (AFB) of her parent suggestive to TB. The tuberculin test was negative, however the patient was severely malnourished. Despite of there was no chronic cough and lymphadenopathy or bone and joint involvement, the chest X-ray result showed milliary appearance and calcification on the left perihiler. Bacteriological confirmation revealed positive result. Even though the sputum AFB revealed negative result and the GeneXpert® detected Mycobaterium tuberculosis (MTB) with negative rifampicin resistancy, the strongest evidence of renal TB was the positive result of urine polymerase chain reaction (PCR). Therefore, she was diagnosed as milliary and renal TB and treated by a regiment consist of four anti-tuberculosis drugs with significant clinical improvement.
Learning Points/Discussion : In tuberculosis endemic countries, we should consider sterile pyuria as a sign of renal tuberculosis in children with recurrent UTI.
Keywords: Renal tuberculosis Sterile pyuria Prolonged fever Severely malnourished children