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Spontaneous Nephrocutaneous Fistula With Tuberculous Autonephrectomy: A Case Report of a Delayed Diagnosis


1 Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
*Corresponding Author: Murat Akand, Department of Urology, School of Medicine, Selcuk University, 42075 Selcuklu, Konya, Turkey. Tel: +90-5327438333, Fax: +90-3322412184, E-mail: drmuratakand@yahoo.com.
Iranian Red Crescent Medical Journal. 18(6): e24407 , DOI: 10.5812/ircmj.24407 | PMID: 27621917 | PMCID: PMC5002966
Article Type: Case Report; Received: Oct 8, 2014; Revised: Mar 25, 2015; Accepted: May 17, 2015; epub: Feb 6, 2016; collection: Jun 2016

Abstract


Introduction: Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected.

Case Presentation: We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 51 × 60 mm area with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9 mm diameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB.

Conclusions: Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.

Keywords: Autonephrectomy; Nephrocutaneous Fistula; Tuberculosis; Chronic Infection

Footnotes

Authors’ Contribution: Murat Akand, Ozcan Kilic, and Serdar Goktas diagnosed the patient; Murat Akand, Mustafa Kucur, and Mehmet Kaynar treated the patient; Murat Akand and Ozcan Kilic prepared the manuscript.

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Figure 1.

Fistulography Showing Drainage of Contrast Agent to the Kidney and Retroperitoneal Space

Figure 2.

CT Scan Demonstrating an Area of Soft-Tissue Appearance That Implies Right Autonephrectomy, as Well as the Fistula Tract Between the Skin and Retroperitoneal Space