Atypical presentation of a case of renal tuberculosis and cardiac muscle bypass

Abstract

Tuberculosis is an endemic disease in several countries, despite having treatment and cure available. The most common form is pulmonary, but it can also affect any other organ or tissue. A male patient, 43 years old, with important sociodemographic history, as he lives at 3000 meters above sea level in a rural area of the Ecuadorian Sierra, presents acute weight loss and asthenia. He had two hospital admissions with an interval of 1 month, during which he required intensive care for comprehensive management. During the first hospitalization, he presented abdominal septic shock, acute renal failure, and acute myocardial infarction. Coronary angiography was performed, which revealed a muscular bridge in the anterior descending artery. During the second hospitalization, he presented septic shock with a urinary focus. As the symptoms were similar and no underlying diagnosis was found to trigger instability, a simple and contrast-enhanced CT scan was performed, which showed suggestive images of a renal abscess and bilateral apical nodules with a tree-in-bud pattern in the chest. Therefore, a study was performed to detect tuberculosis.