SAT-434 RENAL TUBERCULOSIS: A CASE REPORT FROM UNIVERSITY TEACHING HOSPITAL OF KIGALI (CHUK)

Abstract

Urogenital tuberculosis constitutes a current public health problem especially in endemic areas. Renal tuberculosis is among rare form of extra pulmonary tuberculosis (EPTB) and the clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon and differential diagnosis may include even malignant tumors like renal cell carcinoma. Diagnosis require renal biopsy which is a specialized procedure. Prompt treatment of the underlying TB focus can prevent progression to end-stage renal disease. Treatment of renal TB includes surgery followed by anti- tuberculosis treatment. We report a case of renal TB, presented as kidney tumor. On histology TB was suspected and confirmed by Auramine stain at University Teaching Hospital of Kigali (CHUK). We report a 49 years old male, consulted with left kidney mass who underwent left nephrectomy. Histological findings were suggestive of renal tuberculosis, confirmed by auramaine stain. This is a 49 years old male presented with left kidney mass invading vena cava, left nephrectomy was performed and vena cava thrombus was sampled. The nephrectomy specimen was weighing 1792g and measuring (17x14x11) cm. The kidney outer surface was multinodulated, cystic and firm with intact capsule. The renal parenchyma was almost entirely involved by multiple small cysts like lesions, firm and grey. The hilum was also involved by cystic lesions. The so called vena cava thrombus were two fragments of (2x1.7x1) cm, firm and grey. Histology showed extensive caseous necrosis creating pseudocyst cavities, numerous Langhans-type multinucleated giant cells. Fragments of tissue labeled ‘thrombus from vena cava’ showed granulomatous inflammation with frequent Langhans-type multinucleated giant cells. Auramine stain was positive for acid fast bacilli (AFB). Figure legend Photomicrographs of Renal tuberculosis: A: Pseudoyst (H&E, X40). B: Necrosis (H&E, X100). C: Multinucleated giant cells (H&E, X100). D: Chronic inflammatory cells (H&E, X100). Dour text here Cour text here Bour text here Aour text here Renal tuberculosis is very rare and pseudotumoral presentation of urogenital tuberculosis is extremely rare. Renal tuberculosis should be suspected when atypical renal masses are seen in patients from tuberculosis endemic areas.