Multisystem tuberculosis

Case contributed by Utkarsh Kabra
Diagnosis almost certain

Presentation

Abdominal pain and weight loss.

Patient Data

Age: 30 years
Gender: Male
ct

The study reveals concentric thickening and narrowing of cecum, terminal, distal ileum with pulled up ileocecal junction, causing dilatation of proximal small bowel loops consistent with ileocecal tuberculosis.

Significant surrounding edema and fat stranding is seen with multiple small mesenteric lymph nodes. Prominence of mesenteric vessels is also seen in right iliac fossa.

Few other doubtful areas of mucosal hyperemia/wall thickening is seen involving ileum.

Mild free fluid is seen pelvis on right side.

Ill-defined hypodense areas are seen in upper pole of right kidney with splaying, compression of upper, mid polar calyces. Irregular soft tissue with peripheral hyperdensity is seen in right renal pelvis, extending up to pelviureteric junction causing minimal hydronephrosis. Mild hold up of contrast is seen in excretory phase in right pelviureteric junction/upper ureter. These findings are suggestive of renal papillary necrosis, possibly tubercular. Other possibility of inflammatory etiology is less likely.

Left kidney and ureter are unremarkable.

Bilateral adrenal glands are enlarged with lobulated contours and heterogeneous enhancement on postcontrast study suggesting adrenal tuberculosis.

Visualized sections of bilateral lungs show multiple tiny centrilobular nodules on either side consistent with pulmonary tuberculosis.

Case Discussion

In a country like India, where tuberculosis is endemic, this case shows multisystemic involvement of tuberculosis.

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