To investigate the clinical characteristics and diagnostic points of urinary tract tuberculosis.

The clinical data of a patient with urinary tract tuberculosis who suffered from weight loss, recurrent fever, fatigue and headache, admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine on June 17th, 2022 were analyzed and relevant literatures were reviewed.

The patient was a 58-years-old female who has lost 7.5 kg weight in the past six months. The case developed a fever longer than a week ago and a low fever in the afternoon, with a maximum body temperature of 37.7 ℃, and complicated with fatigue and headache. The chest CT scan showed proliferative lesions and lymph nodes in both upper lobes of the lungs, and fibrous lesions in the middle lobe of the right lung, without any signs of Mycobacterium tuberculosis infection. Color doppler ultrasound showed no obvious enlarged lymph nodes in both necks, thickening of the intima media in both carotid arteries, no obvious abnormalities in both vertebral arteries, cystic hyperplasia of both breasts, no obvious enlarged lymph nodes in both armpits. After cholecystectomy, no obvious dilation of the intrahepatic and extrahepatic bile ducts was observed, and no obvious abnormalities were found in liver, pancreas and spleen. No obvious abnormalities were found in both kidneys, ureters and bladder. Urinary routine: negative occult blood in urine, urinary red blood cells was 5 cells/μl. The Mycobacterium tuberculosis infection T cell spot test (T-SPOT.TB) showed 5 spots on MTB antigen (ESAT-6) and 1 spot on MTB antigen (CFP-10), the result was negative, while the purified protein derivative test (PPD) showed a positive result for a wind mass diameter of 35 mm × 18 mm. The result of random urine test for acid fast bacteria was negative, and 12 hours of urine test for acid fast bacteria was positive for 2 consecutive times, and finally the patient was discharged from the hospital with urinary tract tuberculosis infection as the main diagnosis and transferred to the designated tuberculosis hospital for further treatment.

Early diagnosis of urinary tract tuberculosis is difficult and a comprehensive analysis of clinical manifestations and various examination results is required.