Older Smoker Struggles with Uncommon Combinations of Tuberculosis in Bladder and Lungs: Case Study

A 60-year-old male, with a history of heavy smoking, presented with unusual symptoms including microscopic hematuria, left iliac crest pain, and thoracic spine discomfort localized to T11 and T12.

Initial investigations revealed an abnormality on an ultrasound, showing a sessile bladder tumor measuring 3 cm, located near the left ureteral meatus, with associated left hydroureteronephrosis. Further examination through computed tomography (CT) of the thorax, abdomen, and pelvis (TAP) confirmed these findings, also revealing a thickened bladder wall, predominantly involving the left lateral wall. The thickened bladder mass measured 19 mm in length, without further upstream dilation.

The CT scan also detected additional anomalies. It revealed a thickened and enhanced premeatal ureter segment, as well as a left apico-dorsal pulmonary lesion. The pulmonary lesion, measuring 18 x 18 mm, was suspected to be either infectious or neoplastic.

Tuberculous cystitis, a form of tuberculosis that affects the bladder, can often present with nonspecific symptoms such as hematuria, urinary frequency, and pelvic pain. In this case, the CT and biopsy results confirmed the presence of tuberculosis. The biopsy of the bladder mass revealed granulomatous inflammation with multinucleated giant cells and caseating necrosis, consistent with tuberculosis.

The coexistence of pulmonary tuberculosis underscores the systemic nature of the disease. PCR testing for Mycobacterium tuberculosis on bladder tissue was positive, while sputum smears were negative but PCR-positive. This case underscores the importance of biopsy and PCR in confirming TB.

Figures 1, 2, and 3 depict the findings mentioned above. The patient underwent imaging and biopsy for evaluation of hematuria and systemic symptoms.

It is important to note that tuberculous cystitis can mimic bladder malignancies, leading to diagnostic delays. This case serves as a reminder of the importance of thorough investigation and accurate diagnosis in such cases.

The diagnosis in this case was made by the attending physician responsible for the patient's examination and documentation, who carries the responsibility for the diagnosis entered in the medical record.

This case highlights the complexities and challenges in diagnosing and managing tuberculosis, emphasizing the need for continued research and improved diagnostic tools.

Older Smoker Struggles with Uncommon Combinations of Tuberculosis in Bladder and Lungs: Case Study