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Paper text:
we report a case that presented with an infra - umbilical mass that turned out to be tuberculosis of the urachal cyst .
a 23-year - old male presented with mild intermittent peri - umbilical pain and low - grade fever for 3 months .
there was a history of loss of appetite and weight loss ( 4 kg over 3 months ) .
there was no significant medical or surgical history . on examination , the patient 's vitals were stable and his physical examination was normal except for a well - circumscribed , non - tender mass , about 5  5 cm in size , which was palpable in the infra - umbilical area .
a routine hemogram , serum biochemistry , liver function , and renal function tests were within normal limits .
contrast - enhanced computed tomography ( ct ) of the abdomen was suggestive of a smooth - walled , cystic mass measuring 5  5  6 cm , located above the bladder ( fig .
fine - needle aspiration cytology revealed necrotic material . with a clinical diagnosis of an urachal abscess ,
, the mass was located in the pre - peritoneal space , just above the bladder .
the mass was separated from the bladder and could be excised en bloc ( fig .
, urothelium was found along with multiple granulomas , caseation , and epitheloid and langhans cells , suggestive of urachal tuberculosis ( fig .
the patient was started on combination anti - tubercular therapy with rifampicin , isoniazid , ethambutol , and pyrazinamide , which were given for 2 months .
culture of the pultaceous material on lowenstein - jensen media confirmed the presence of mycobacterium tuberculosis ; the bacilli were sensitive to isoniazid , rifampin , and ethambutol .
blood , sputum , and urine cultures performed three times during the post - operative period were sterile .
the patient was then continued on a combination of rifampicin and isoniazid for 4 months , according to national guidelines .
follow - up ct of the abdomen after the completion of anti - tubercular treatment revealed no evidence of disease .
it normally disappears during the first 4 to 5 months of gestation , ultimately becoming a fibrous cord .
tuberculosis of the urachal cyst is extremely rare ; we are aware of only one case described in the english language literature to date .
in contrast , we could find no evidence of active or old pulmonary tuberculosis in our patient .
blood , urine , and sputum cultures failed to reveal any growth on lowenstein - jensen media . in our country
, tuberculosis is an endemic disease that occurs at an early pediatric age , and tubercular infection is a universal phenomenon . a primary lesion , which is most often pulmonary ,
we presume that the tubercular infection of the urachal cyst in the case presented was due to re - activation of latent tubercular foci , which were already present in the cyst , due to seeding at the time of primary tuberculosis . en bloc excision of the abscess
medical treatment with anti - tubercular medications must be started along the lines of genitourinary tuberculosis . in conclusions ,
the possibility of tuberculosis should be considered during the work - up of an urachal abscess .
urachal cysts are uncommon . 
 rarely , these cysts can become infected . 
 tuberculosis of the urachal cyst is exceedingly rare , with only one case reported previously in the english language literature . here 
 we report the case of a 23-year - old male who presented with an infra - umbilical mass that turned out to be tuberculosis of the urachal cyst .