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Obstructive uropathy as initial presentation of genitourinary tuberculosis and masquerading as a postsurgical complication
  1. Grace Igiraneza1,
  2. Theobald Hategekimana2,
  3. Olivier M Manzi3,
  4. Onyema Ogbuagu3,4
  1. 1Nephrology unit, Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
  2. 2Urology Unit, Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
  3. 3Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
  4. 4Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Onyema Ogbuagu, onyema.ogbuagu{at}


A 46-year-old woman who had a recent total abdominal hysterectomy presented with a 1 month history of lower abdominal pain, 1 week of nausea and vomiting as well as decreased urinary output preceded by a year of significant unintentional weight loss. On renal imaging, she was found to have bilateral hydronephrosis and hydroureters in the setting of bilateral distal ureteric obstruction complicated with acute kidney injury and severe hyperkalaemia requiring haemodialysis. The initial concern was for ureteric injury, a known complication of abdominal hysterectomy procedures, however, a urological intervention, performed 9 months later to relieve the ureteric obstruction, revealed purulent material within the left ureter that was smear positive for acid fast bacilli. A GeneXpert test was positive for Mycobacterium tuberculosis. She was diagnosed with genitourinary tuberculosis and responded well to antitubercular treatment and haemodialysis was discontinued after the surgery relieved her ureteric obstruction.

  • global health
  • Tb and other respiratory infections
  • urinary tract infections
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  • Contributors GI, TH both provided direct clinical care to the patient and identified this case as worth sharing. GI, TH, OMM, OO were responsible for conception of the article, literature search, drafting and revision of the article as well as approval of the submitted draft.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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