NEPHROCUTANEOUS FISTULA, A RARE PRESENTATION OF TUBERCULOSISCASE REPORT

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.