NEPHROCUTANEOUS FISTULA, A RARE PRESENTATION OF TUBERCULOSISCASE REPORT

Abstract

Nephrocutaneous fistula is defined as
abnormal communication between the
kidney andthe skin. A 55 year old, diabetic
and hypertensive male presented
with complaints of pus dischargingsinus
over left flank for one month duration. He
had undergone open drainage for left
sidedperinephric abscess before six
months. Anemia was evident by haemotologic
investigation and thepus culture
revealed Proteus and urine culture, Klebsiella
organisms significantly. Both USG
andCECT revealed contracted left kidney,
with the later showing a fibrous like
band connecting the leftkidney and abdominal
wall. Fistulogram was evident as
the contrast injected entered left renal
pelvis,ureter and bladder. In view of the
poor function demonstrated by the DTPA
renogram and thepersistent fistulous
tract, nephrectomy was proceeded with
the excision of the fistulous tract. The
histopathologic surprise was tuberculosis
and the patient was treated with ATT.
Manifestation ofGUTB as a fistula per se is
very rare and masking the disease by
negative investigations butrevealing after
nephrectomy gives an indication that the
disease could exist in the dormant stateproducing
such pathology.