A 70-year-old man was admitted to our hospital with a right cerebellar ischemic stroke. The physical examination revealed neurologic findings consistent with this diagnosis. Routine plain anteroposterior radiography of the chest unexpectedly revealed a cavitary lesion in the upper left lung and a large calcification in the left abdomen (Panel A, arrow). Subsequent abdominal radiography revealed a calcification in the region of the left kidney (Panel B, arrow) and tubular calcifications in the region of the left ureter (Panel B, arrowhead). Axial computed tomographic imaging showed that the cavitary lung lesion lay within the posterior segment of the left upper lobe and was associated with an enlarged right paratracheal lymph node with central necrosis (Panel C, arrow). A densely calcified, atrophic left kidney was also apparent (Panel D, arrow). A serum interferon-gamma release assay was positive for Mycobacterium tuberculosis. Repeated sputum and urine acid-fast bacilli smears and cultures were negative, and the patient was asymptomatic with normal renal function. A diagnosis of left autonephrectomy secondary to renal tuberculosis and probable cavitary tuberculosis of the left upper lobe was made. In countries in which tuberculosis is endemic, it is important to have a high index of suspicion for tuberculosis in patients with renal calcifications in order to facilitate treatment and to prevent autonephrectomy.

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