A previously healthy 35-year-old man presented with a 2-month history of intermittent gross hematuria, dysuria, and a 2 kg weight loss. Two weeks before admission to our hospital, he was treated with empirical antibiotics for cystitis at a local urology clinic without improvement in symptoms. An enhanced abdominal computed tomography (CT) scan performed 10 d prior was highly suggestive of multiorgan TB involvement, including the kidneys, intestines, and lymph nodes (
Fig. 1A-C). Upon admission, the patient was alert, with a temperature of 36.2℃, blood pressure of 116/75 mmHg, and a pulse rate of 70 beats/min. Physical examination revealed tenderness in the lower right quadrant of the abdomen. Laboratory findings were as follows: white blood cell count, 5,900/μL (normal, 4,000-10,000); C-reactive protein level, 1.7 mg/dL (normal, 0.0-0.3); erythrocyte sedimentation rate, 78 mm/h (normal, 0-20); alkaline phosphatase level, 283 IU/L (normal, 104-338); alanine aminotransferase level, 17 IU/L (normal, 4-44); aspartate aminotransferase level, 14 IU/L (normal, 8-38); and creatinine level, 0.9 mg/dL (normal, 0.8-1.3). Urinalysis revealed microscopic hematuria and pyuria. Chest CT revealed an active pulmonary TB lesion (
Fig. 1D). However, the patient denied any history of TB exposure and did not exhibit any respiratory symptoms. Additionally, he had received the Bacille Calmette-Guerin vaccine during childhood. On the 5th day of hospitalization, urine and blood cultures showed no bacterial growth, but polymerase chain reaction testing for M. tuberculosis and acid-fast bacilli staining on a urine specimen were positive. On the 6th day of admission, colonoscopy revealed active intestinal TB involving the terminal ileum and ileocecal valve (
Fig. 2A). TB-polymerase chain reaction tests of sputum and ileal ulcer tissues obtained via colonoscopy were also positive. Based on these findings, the patient was diagnosed with disseminated TB, and induction therapy with anti-TB drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) was initiated. Antimicrobial-susceptible
Mycobacterium tuberculosis was identified in urine, sputum, and intestinal tissue a month after discharge. Further laboratory tests showed the following results (
Table 1): HIV antigen/antibody test, negative; testosterone level, 5.46 ng/mL (normal, 5.40-40.00); 25-OH vitamin D level, 25.8 ng/mL (normal, >10); immunoglobulin (Ig) A, 215 mg/dL (normal, 84-438); IgM, 134 mg/dL (normal, 57-288); IgG, 1,275 mg/dL (normal, 680-1,620); CD4+ T-cell count, 278/μL. CD3+ T-cell, CD19 B-cell, and CD16+ CD56 natural killer cell counts were within the normal ranges. The patient received anti-TB medication for 6 months and fully recovered without renal failure during the 1-year follow-up period. However, his CD4+ T-cell count did not improve.