Tuberculosis-Induced Bronchiectasis Complicated by Recurrent Respiratory Tract Infections and Renal Amyloidosis: A Classic Revisited

In this case, a young male patient with a past medical history of adequately treated pulmonary tuberculosis (TB), presented with pedal edema, proteinuria, and evidence of bilaterally enlarged kidneys on renal ultrasound, raising suspicion of renal amyloidosis. Cough, expectoration, severe dyspnea, and high-resolution computed tomographic changes of dilated bronchi paralleled evidence of bronchiectasis exacerbated by perpetual bacterial infection. In view of the laboratory findings and imaging studies, a renal biopsy was done, and it supported the diagnosis of secondary amyloidosis in the kidneys. Clearly, TB infection, although treated, had exerted a multifaceted effect, and it ran a downward spiral from there: the simultaneous occurrence of bronchiectasis and recurrent respiratory tract infections, renal amyloidosis, nephrotic syndrome and an inevitable end-stage renal failure in just the third decade of life. It makes sense then, to use adjuvant steroid therapy as complementing traditional TB therapy to combat the destructive and fibrosing properties of pulmonary TB.