TY - JOUR T1 - Tetraparesia: an unusual presentation of disseminated tuberculosis JF - BMJ Case Reports DO - 10.1136/bcr-2017-219579 VL - 2017 SP - bcr-2017-219579 AU - Filipa Quaresma AU - Margarida Bentes Jesus Y1 - 2017/08/10 UR - http://casereports.bmj.com/content/2017/bcr-2017-219579.abstract N2 - 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. ER -