Tuberculous peritonitis in a case receiving continuous ambulatory peritoneal dialysis(CAPD) treatment

Garip Sahin,Nuri Kiraz,Mehmet Soydan,Ilknur Sahin,Yurdanur Akgün

doi:10.1186/1476-0711-3-19

Abstract

BackgroundTuberculosis continues to be an important health problem in the world. Besides pulmonary involvement extrapulmonary involvement becomes an affair in developing countries, even in developed countries.Case presentationA thirty-six year old male patient was admitted with abdominal pain, diarrhea, nausea, vomiting and fever which had started one week before. The patient had been followed up with predialisis Chronic Renal Failure(CRF) diagnosis for 4 years and receiving continuous ambulatory peritoneal dialysis (CAPD) treatment for 4 months. In peritoneal fluid, 1600/mm3 cells were detected and 70% of them were polymorphonuclear leukocytosis. The patient begun nonspesific antibiotherapy but no benefit was obtained after 12 days and peritoneal fluid bacterial cultures remained negative. Peritoneal smear was positive for Asid-fast basilli (AFB), and antituberculosis therapy was started with isoniazid, rifampicine, ethambutol and pyrazinamide. After 15 days his peritoneal fluid cell count was decreased and his symptoms were relieved. Peritoneal fluid tuberculosis culture was found positive.ConclusionConsidering this case, we think that in patients with CAPD catheter and peritonitis; when peritoneal fluid leukocytes are high and PMNL are dominant, AFB and tuberculosis culture must be investigated besides bacterial culture routinely.

Highlights

Tuberculosis continues to be a devastatingly important health problem in the world
Considering this case, we think that in patients with continuous ambulatory peritoneal dialysis (CAPD) catheter and peritonitis; when peritoneal fluid leukocytes are high and polymorphonuclear leukocytosis (PMNL) are dominant, Asid-fast basilli (AFB) and tuberculosis culture must be investigated besides bacterial culture routinely
The risk increases in hemodialisis patients

Summary

Introduction

Tuberculosis continues to be a devastatingly important health problem in the world. In addition to pulmonary involvement, extrapulmonary involvement becomes an issue in most developing countries. Tuberculosis comes out extrapulmonary with a rate of 40 percent in these patients, and periton is involved in 6 percent of all cases [2]. The peritoneal fluid of the patient was sent to be examined with Gram staining and Ziehl Neelsen staining. Two specimens were later sent to be examined with Ziehl Neelsen staining on two different days. Both of them were detected to be positive for Ziehl Neelsen staining. Acid-fast basilli (AFB) was found to be positive in the gram staining of peritoneal fluid in the remaining follow up periods, and the patient had begun antituberculosis therapy in fours(with isoniazid, rifampin, ethambutol and pyrazinamide).

Discussion

Findings

Cengiz K