Persistent sterile pyuria in children? Don't forget tuberculosis!

Chiang LW, Jacobsen AS, Ong CL, Huang WS
Correspondence: Dr Chiang Liwei, chiang.li.wei@singhealth.com.sg

ABSTRACT
Genitourinary tuberculosis (GUTB) is exceptionally uncommon among the local paediatric population. A 10-year-old Chinese girl with no risk factors for tuberculosis presented with recurrent sterile pyuria. Despite extensive renal investigations, no apparent cause could be ascertained for her obstructed left drainage system. The diagnosis was eventually confirmed with urine acid-fast bacilli culture, after a computed tomography scan suggested possible renal tuberculosis. A left nephroureterectomy had to be performed owing to deteriorating left kidney function. This report discusses the importance of considering tuberculosis when assessing a local paediatric patient with an atypical urinary tract infection. Early diagnosis of renal tuberculosis can prevent the sequelae of GUTB, including renal impairment.

Keywords: genitourinary tuberculosis, nephroureterectomy, sterile pyuria, tuberculosis pyelonephritis, urinary tract infection
Singapore Med J 2010; 51(3): e48-e50