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Unusual presentation of more common disease/injury
CASE REPORT
Curious case of fever of unknown origin
  1. Manasvini Bhatt1,
  2. Manish Soneja2,
  3. Madhavi Tripathi3 and
  4. Ashutosh Biswas4
  1. 1 Junior Resident, Department of Medicine, All India Institute of Medical Sciences, New Delhi
  2. 2 Associate Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  3. 3 Associate Professor, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
  4. 4 Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi
  1. Correspondence to Dr Manish Soneja, manishsoneja{at}gmail.com

Abstract

A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for Mycobacterium tuberculosis with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.

  • infections
  • urinary and genital tract disorders

http://dx.doi.org/10.1136/bcr-2018-227258

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    Footnotes

    • Contributors MB was the primary physician of the patient. MS and AB were consultant in charge of the patient and were involved in management, literature review and compiling the case report. MT helped in literature review of radiodiagnosis and nuclear medicine and contributed in draft preparation and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.