{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:27Z","timestamp":1756339527027,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,13]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET\/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for <jats:italic>Mycobacterium tuberculosis<\/jats:italic> with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET\/CT scan are discussed in this report.<\/jats:p>","DOI":"10.1136\/bcr-2018-227258","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"bcr-2018-227258","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Curious case of fever of unknown origin"],"prefix":"10.1136","volume":"11","author":[{"given":"Manasvini","family":"Bhatt","sequence":"first","affiliation":[{"name":"Junior Resident, Department of Medicine, All India Institute of Medical Sciences, New Delhi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manish","family":"Soneja","sequence":"additional","affiliation":[{"name":"Associate Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhavi","family":"Tripathi","sequence":"additional","affiliation":[{"name":"Associate Professor, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashutosh","family":"Biswas","sequence":"additional","affiliation":[{"name":"Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,3]]},"reference":[{"key":"2025082709012513000_11.1.bcr-2018-227258.1","first-page":"10","article-title":"Overview of fever of unknown origin in adult and paediatric patients","volume":"36 Suppl 110","author":"Attard","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"2025082709012513000_11.1.bcr-2018-227258.2","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/hdi.12471","article-title":"Utility of 18 F-FDG PET\/CT scan to diagnose the etiology of fever of unknown origin in patients on dialysis","volume":"21","author":"Tek Chand","year":"2017","journal-title":"Hemodial Int"},{"key":"2025082709012513000_11.1.bcr-2018-227258.3","first-page":"316","article-title":"Extrapulmonary tuberculosis","volume":"120","author":"Sharma","year":"2004","journal-title":"Indian J Med Res"},{"key":"2025082709012513000_11.1.bcr-2018-227258.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2011.172"},{"key":"2025082709012513000_11.1.bcr-2018-227258.5","doi-asserted-by":"publisher","DOI":"10.1007\/s11934-008-0053-9"},{"key":"2025082709012513000_11.1.bcr-2018-227258.6","doi-asserted-by":"crossref","first-page":"6181","DOI":"10.1038\/s41598-017-06517-0","article-title":"GeneXpert MTB\/RIF assay in the diagnosis of urinary tuberculosis from urine specimens","volume":"7","author":"Pang","year":"2017","journal-title":"Sci Rep"},{"key":"2025082709012513000_11.1.bcr-2018-227258.7","doi-asserted-by":"publisher","DOI":"10.4103\/0971-3026.113615"},{"key":"2025082709012513000_11.1.bcr-2018-227258.8","doi-asserted-by":"crossref","unstructured":"Wang Q , Li Y-M , Li Y , et al . 18F-FDGPET\/CT in fever of unknown origin and inflammation of unknown origin: a Chinese multi-center study. Eur J Nucl Med Mol Imaging 2018;40.doi:10.1007\/s00259-018-4121-1","DOI":"10.1007\/s00259-018-4121-1"},{"key":"2025082709012513000_11.1.bcr-2018-227258.9","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1007\/s00247-018-4141-9","article-title":"Whole-body magnetic resonance imaging: techniques and non-oncologic indications","volume":"48","author":"Greer","year":"2018","journal-title":"Pediatr Radiol"},{"key":"2025082709012513000_11.1.bcr-2018-227258.10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.3389\/fonc.2016.00201","article-title":"The Place of FDG PET\/CT in Renal cell carcinoma: Value and limitations","volume":"6","author":"Liu","year":"2016","journal-title":"Front Oncol"},{"key":"2025082709012513000_11.1.bcr-2018-227258.11","doi-asserted-by":"crossref","first-page":"117","DOI":"10.3947\/ic.2015.47.2.117","article-title":"Dual Time Point (18)F-FDG PET\/CT Imaging identifies bilateral renal tuberculosis in an immunocompromised patient with an unknown primary malignancy","volume":"47","author":"Subramanyam","year":"2015","journal-title":"Infect Chemother"},{"key":"2025082709012513000_11.1.bcr-2018-227258.12","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2013.12-0413"},{"key":"2025082709012513000_11.1.bcr-2018-227258.13","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00059014"},{"key":"2025082709012513000_11.1.bcr-2018-227258.14","doi-asserted-by":"crossref","first-page":"485","DOI":"10.2214\/ajr.155.3.2117344","article-title":"Imaging of chronic renal infections","volume":"155","author":"Kenney","year":"1990","journal-title":"AJR Am J Roentgenol"},{"key":"2025082709012513000_11.1.bcr-2018-227258.15","unstructured":"Elkin M . Urogenital tuberculosis: In. Pollack HM , ed. Clinical Urography. Philadelphia: WB Saunders, 1990:1020\u201352."},{"key":"2025082709012513000_11.1.bcr-2018-227258.16","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/0971-3026.113617","article-title":"Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part II","volume":"23","author":"Merchant","year":"2013","journal-title":"Indian J Radiol Imaging"},{"key":"2025082709012513000_11.1.bcr-2018-227258.17","first-page":"407","article-title":"[Significance of the CT scan in renal tuberculosis]","volume":"24","author":"Lu","year":"2001","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi"},{"key":"2025082709012513000_11.1.bcr-2018-227258.18","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-011-1374-z"},{"key":"2025082709012513000_11.1.bcr-2018-227258.19","first-page":"320","article-title":"Prognosis in bilateral renal tuberculosis","volume":"45","author":"Braasch","year":"1941","journal-title":"Can Med Assoc J"},{"key":"2025082709012513000_11.1.bcr-2018-227258.20","doi-asserted-by":"crossref","first-page":"362","DOI":"10.4103\/0970-1591.42619","article-title":"Medical management of genitourinary tuberculosis","volume":"24","author":"Kadhiravan","year":"2008","journal-title":"Indian J Urol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bcr-2018-227258","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-227258","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:01:36Z","timestamp":1756310496000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-227258"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,3]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bcr-2018-227258"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-227258","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}