EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY COMPLICATED WITH MILIARY TUBERCULOSIS

We report a case of miliary tuberculosis following extracorporeal shoc k wave lithotripsy (ESWL). The patient had right lower caliceal and l eft distal ureteral calculi on excretory urography. He was hospitalize d 50 days after ESWL with fever, weight loss and night sweats. Liver f unction tests were abnormal and he had hypoxemia. A chest x-ray at hos pitalization was normal but a miliary pattern developed 10 days later. Diagnosis was tuberculosis based on culture of sputum in a Lowenstein medium. Liver biopsy confirmed caseating epithelioid granulomas. Anti tuberculous treatment was successful. We conclude that renal tuberculo sis associated with calcification must be ruled out before treatment w ith ESWL to avoid a possible hematogenous dissemination.