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Tetraparesia: an unusual presentation of disseminated tuberculosis
  1. Filipa Quaresma,
  2. Margarida Bentes Jesus
  1. Department of Internal Medicine, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
  1. Correspondence to Dr Filipa Quaresma, fquaresma15{at}


A 48-year-old man with a 4 months history of asthenia, anorexia, 10 kg weight loss and 1 month of hematuria and dysuria was admitted to another hospital for sudden muscular weakness. He was found to have areflexic tetraparesis and was referred to our hospital.

On admission, he was bradycardic, tachypneic, with flaccid tetraplegia. Laboratory results showed metabolic acidemia, severe hyperkalemia and hyponatremia, acute renal dysfunction and sterile pyuria. After hyperkalemia correction, the neurological symptoms resolved.

On the second day, he became febrile and chest radiograph and CT images showed a pulmonary bilateral reticulomicronodular pattern, left hydronephrosis and diffuse bladder wall thickening. Disseminated tuberculosis was considered as diagnosis by the coexistence of this imagiologic alterations and sterile pyuria. Acid-fast test for Mycobacteriumtuberculosis was negative, but the urine culture became positive after 2 weeks.

Antituberculosis treatment was started. One year later, he was asymptomatic and the structural urinary lesions had disappeared.

  • infections
  • TB and other respiratory infections
  • urinary tract Infections
  • hematuria
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  • Contributors The two authors were involved with the patient case and the diagnosis. Both considered the case relevant to publication and collaborated doing the manuscript draft and its review, reaching this submitted version.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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