We report a case in line with the SCARE criteria. A case of a 19 years old high secondary school student from western Sudan who was presented with right loin pain and weight loss for two months, he complains of intermittent low-grade fever, and fatigue, there was no hematuria, night sweating, cough or history of contact with a patient of tuberculosis. On abdominal examination, he was cachexic, not pale or jaundiced, the right kidney was bimanually palpable, temperature was 37.1  C, blood pressure 110/70 mmHg, and pulse rate regular at 76 beats/min. Laboratory investigations revealed hemoglobin of 9 g/dl, total leukocyte count 12,200 C/mm, and elevated erythrocyte sedimentation rate of 95 mm/hr. Renal function test and other biological investigation results were normal.
Urinalysis demonstrated acidic pH, leukocytes 1+, protein nil, erythrocytes 1+, nil leukocyte casts, and negative culture of the urine for pyogenic agents.
CT urography revealed right-solid mass involving the entire kidney and shows heterogeneous enhancement with multiple enlarged para-aortic lymph nodes, the lesion was suggestive of renal cell carcinoma. The urinary bladder was normal. Both ureters were normal as well as the left kidney and no hydronephrosis (Figs. 1 and 2). Considering the clinical presentation as well as laboratory and radiological investigations, a provisional diagnosis of renal cell carcinoma was made, and the patient underwent an open right radical nephrectomy through the right para-median incision using the trans-peritoneum approach. Intraoperative findings were normal peritoneum, liver and bowel. The right kidney was completely involved and mobile. Radical nephrectomy was done and the specimen was sent for histopathological examination. The patient's postoperative course was uneventful. The patient was discharged on the third day, he came after 7 days for follow up, his relatives noticed right-side weakness and accordingly CT brain was requested. It revealed features of brain abscess and surprisingly, histopathological examination of the specimen revealed microscopic features tubercles granuloma (Fig. 3, Fig. 4, Fig. 5). In concordance with the previous histopathology tuberculous brain abscess was highly suspicious. The patient was referred to the neurosurgery department where a decision of drainage was taken. PCR confirmed TB. The patient received antituberculous and continue to follow up with the neurosurgery department.