Delayed diagnosis of genitourinary tuberculosis after urologic procedure leads to severe inflammatory response and possible disseminated infection

Background Genitourinary disease is a rare manifestation of tuberculosis (TB) and can present without pulmonary involvement. Atypical presentations may result in delayed diagnosis, leading to serious complications and poor outcomes. Case Summary We present a case of a 43-year-old patient with chronic suprapubic pain, dysuria, and sterile pyuria. Cystoscopy revealed white plaques on the bladder mucosa; biopsy showed non-caseating granulomas. After bladder biopsy and ureteral stenting, she developed multi-organ failure and acute respiratory distress syndrome (ARDS). Urinary and respiratory PCR and culture confirmed Mycobacterium tuberculosis . She received rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy and was discharged home. Conclusion This case highlights the importance of clinical suspicion for genitourinary tuberculosis (GUTB) in patients with sterile pyuria. Invasive urologic procedures may result in disseminated disease and fulminant deterioration. Early recognition and timely initiation of antituberculosis therapy are crucial for improved survival.