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VISUAL DIAGNOSIS IN EMERGENCY MEDICINE PUTTY KIDNEY, A RESULT OF EXTRAPULMONARY TB OF THE KIDNEY

Published:September 13, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.09.022
      A 57-year-old male patient with a history of benign prostatic hyperplasia, cirrhosis of the liver, and hypertension presented to the Emergency Department (ED) with the chief complaint of urinary urgency and passing blood and blood clots for 2 days. The patient denied other symptoms, including fever, nausea, vomiting, diarrhea, abdominal pain, chest pain, or back pain. He had no previous diagnosis of tuberculosis (TB), however, he was at increased risk due to his proximity to the United States–Mexico border, where TB is endemic. Physical examination was unremarkable, and urinalysis was significant for large blood, white blood cell count of three to five cells per high power field, red blood cell count of > 200 cells per high power field, negative bacteria, with a negative culture. A noncontrast computed tomography scan revealed an atrophic right kidney and dilated calyces containing calcifications consistent with a diagnosis of putty kidney. Additional confirmatory studies were completed as an outpatient, demonstrating a positive purified protein derivative test and urine culture. Initial treatment included a four-drug regime over 2 months followed by a two-drug regime for 6 additional months. The outcome of the patient's treatment was not disclosed.

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