We report the case of a 65-year-old male patient with a history of hypercholesterolemia, AMI-like ischemic heart disease, left ventricular failure (LVEF: 35%), and mild tricuspid, mitral and aortic regurgitation.
Recurrent urinary infections
Chronic renal failure of unknown etiology since 2003.
In a study in Urology at present due to elevation of PSAt (7.36 ng/ml), to which a prostatic biopsy was recently performed pending the result at the time of admission, there was no clinical indication for a renal transplant.
On rectal examination, the prostate showed an elastic consistency not measured.
Blood tests, Biochemistry: Urea: 134 mg/dl. Creatinine: 6.98 mg/dl. FA: 126 U/l.
CRP > 9 mg/dl, other parameters within normal ranges.
Chest X-ray showed bilateral interstitial pattern with intercisural effusion,.
1.
If a pneumonia due to radiographic image is suspected, a Legionella antigen is urgently requested in the urine, which is negative.
The patient was dialyzed and during the session a fever peak of 39o C, extra and hemocultive, was achieved.
Urocultiva was also collected.
Empirical antibiotic therapy with levofloxacin and clarithromycin was prescribed to cover typical respiratory bacteria.
The patient was asymptomatic but a bilateral interstitial pattern persisted on chest X-ray.
persistent fever, despite empirical antibiotic therapy (Levofloxacin, Clarifying cough and Meropenem), and negative hemocultive and urocultive treatment was requested
Due to the persistence of pain in the right lateral lumbosacral region, a toracoabdominal nuclear magnetic resonance was performed, in which bilateral interstitial pulmonary involvement with thickening of interlobular septa and tuberculosis was observed.
Perivascular adenopathies of 1 cm and right paratracheal of 1.2 cm. Severe bilateral cortical atrophy with marked bilateral hydronephrosis.
Alteration in the density of the vertebral bodies L2-L3 with localized tuberculosis mass (a discal level of 2.5 cm thick compatible with spondylodylodyscitis) is diagnosed as ossfluent abscess.
After evaluation by traumatology was decided symptomatic treatment with brace.
1.
The result of the prostatic biopsy performed was adenocarcinoma of the prostate (Gleason 3+2) affecting the right lobe.
Löstein&#146;s anomaly in urine: Positive for Mycobacterium tuberculosis.
Genitourinary tuberculosis and vertebral L2-L3 involvement (Pott's disease) were diagnosed, with tuberculous treatment continued for months/Kg/daysoniazid mg/Kg/day + pyrazinamide 30 mg
Isoniazid + Rifampicin at the same doses for the following 4 months).
