We report the case of a 66-year-old male patient with a history of hyperglycemia on dietetic treatment, doubtful epididymal tuberculosis (TBC), decortication of vocal cords episodes and hematuria from 40 cigarettes.
Physical location: good general condition.
Rectal examination: prostate grade I-II/IV, elastic consistency, conserved limits.
There aren't psychical areas.
Hematocritograms were performed in 4.9% of patients; hematocrit 5.09 million/mm; hemoglobin 15.8 gr/dl; platelet count 47.35%; eosinophils 47,10%; lymphocytes 10,67 thousand/mm.
Coagulation study: no alterations.
Biochemistry: no alterations; PSA 2,9) and urine (systemic urine output: density 1015; pH 6,5; leukocytes 500/microl; negative nitrites; erythrocytes 10/field.
Sedation: abundant leukocytes), with negative urine cytology (severe acute inflammatory component), simple abdominal x-ray in which lithiasis in the lower pole of the left kidney was observed and abdominal ultrasound with normal right kidney, dilated left kidney.
At the vesical level a mass of approximately 1 cm of maximum diameter is observed on the left lateral face.
The IVU showed a left kidney with calvarial dilatation and irregularities in all its contour, dilation of the ureter on the same side, with irregular and tortuous contours, up to the iliac ureter.
In its last 8-10 cm into the bladder, the ureter appears normal.
Cystogram with contour irregularities in its upper portion.
Cystoscopy was performed, revealing a solid tumor in the left side of the bladder and a whitish coloration that prevented the vision of the left ureteral orifice.
Urine culture was requested in Löstein&#146;s anomaly and transurethral resection of the bladder mass was performed.
The postoperative course was uneventful.
Psoriatic arthritis report: tuberculoid granulomatous, compatible with TB.
Lowenstein in urine: positive for Mycobacterium tuberculosis.
She was diagnosed with genitourinary tuberculosis with tuberculoma and left renoureteral involvement. She was started on tuberculous treatment with isoniazid (5 mg/kg/day + pyrazinamide 10 mg/kg/day).
Isoniazid + Rifampicin at the same doses for the following 4 months).
During follow-up (14 months after diagnosis and after treatment completion) she presented fistula with exudate in the left test whose staining showed no AFB, with Lowenstein negative.
He closed with local cures.
Chronic control testicular ultrasound was performed in both epididymis with small bilateral hydrocele.
A control VUI was performed, showing good evolution, improving the function and morphology of the urinary tract (left).
In the last one performed (4 years after diagnosis) there is alteration in the morphology of the lower pole of the left kidney with decrease of the cortical and aberrant calcification associated in the parenchyma, all this in relation to its diagnosis.
Uterus caliber and normal morphology.
Exercise bladder and prostatic hypertrophy
Urine cultures in Löstein&#146;s syndrome were negative after treatment.
