泌尿道結核偽裝成反覆泌尿道感染和腎衰竭：個案報告

Urinary Tuberculosis Masquerading as Recurrent Urinary Tract Infection and Renal Failure: A Case Report

在台灣，泌尿道結核是第三常見的肺外結核疾病。因為泌尿道結核經常是沒有任何症狀，所以容易造成臨床醫師沒有注意而病情惡化進展到慢性腎臟病。我們報告一位個案臨床表現為反覆泌尿道感染、慢性腎衰竭合併急性惡化和腎水腫。腹部電腦斷層報告為雙側腎水腫、輸尿管積水和膀胱壁收縮狹窄。胸部電腦斷層報告為瀰漫性粟粒性結節在雙小葉間下肺野，疑似粟粒性結核病。我們放置雙側經皮腎造口術來避免腎臟功能嚴重惡化。結核尿液和結核痰液培養報告都為結核分枝桿菌。最終病人診斷為泌尿道結核和粟粒性結核病。四合一的抗結核藥物預計使用6到9個來來根治結核病。雖然病人的腎功能無法完全恢復到之前的水準，但也沒再惡化到需要透析治療的情況。我們的個案報告指出在反覆性泌尿道感染的病人，臨床醫師需要非常注意泌尿道結核的可能性。

In Taiwan, urogenital tuberculosis (TB) is the third most common form extrapulmonary TB. Because urogenital TB usually presents with non-specific symptoms, disease progression to chronic renal failure may be delayed in diagnosis due to a lack of clinical awareness. We report a case of recurrent urinary tract infection complicated by- acute-on chronic renal failure and bilateral hydronephrosis. Abdominal computed tomography (CT) revealed bilateral hydronephrosis, hydroureter, and contract bladder. Chest CT revealed diffuse miliary nodules in both lower lung fields, highly suggestive of miliary TB. Bilateral percutaneous nephrostomy (PCN) was performed to prevent renal function deterioration. Urine and sputum TB cultures confirmed Mycobacterium tuberculosis. The patient was ultimately diagnosed with both miliary and urinary TB. A four-drug anti-TB regimen (isoniazid, rifampin, pyrazinamide, and ethambutol) was prescribed for 6–9 months. Continuous PCN drainage was maintained to protect renal function until completion of anti-TB therapy and resolution of hydronephrosis. This case highlights the importance of considering urinary TB in patients with recurrent urinary tract infections, as delayed diagnosis can lead to significant complications.