Tuberculose Rénale Abcédée : À Propos d’un Cas : Abscessed Renal Tuberculosis : A Case Report

Abstract

Renal tuberculosis, a rare form of extrapulmonary tuberculosis (8–10% of cases), results from late hematogenous dissemination of Mycobacterium tuberculosis from an initial focus, most often pulmonary. Its slow and paucisymptomatic course explains why diagnosis is frequently made at an advanced stage, exposing patients to severe complications such as pyonephrosis and renal destruction. In this article, we describe the computed tomography features of chronic pyonephrosis revealing end-stage renal tuberculosis in a 40-year-old HIV-positive woman. Clinical presentation included a painful abdominal mass evolving over several months, intermittent fever, and deterioration of general condition, without associated urinary symptoms. Abdominopelvic computed tomography demonstrated a large left retroperitoneal reniform mass composed of multiple partially calcified fluid-filled cavities corresponding to the calyceal system, with marked thinning of the renal parenchyma and functional renal silence. The absence of urinary lithiasis and the context of immunosuppression supported the diagnosis of pyonephrosis on a tuberculous kidney. This case illustrates the severe course of renal tuberculosis in immunocompromised patients and highlights the major role of medical imaging in diagnosis, assessment of functional impairment, and therapeutic decision-making. It also emphasizes the importance of early medico-surgical management to prevent potentially fatal complications, particularly in tuberculosis-endemic countries.