Clearing the clouds: Case-report and review of the literature.
cloudy dialysate
isoniazid-resistant tuberculosis
peritoneal dialysis
peritoneal tuberculosis
peritonitis
Journal
Seminars in dialysis
ISSN: 1525-139X
Titre abrégé: Semin Dial
Pays: United States
ID NLM: 8911629
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
pubmed:
4
11
2020
medline:
29
10
2021
entrez:
3
11
2020
Statut:
ppublish
Résumé
In peritoneal dialysis (PD), a cloudy dialysate is an alarming finding. Bacterial peritonitis is the most common cause, however, atypical infections and non-infectious causes must be considered. A 46-year-old man presented with asthenia, paraesthesia, foamy urine and hypertension. Laboratory testing revealed severe azotaemia, anaemia, hyperkalaemia and nephrotic-range proteinuria. Haemodialysis was started through a central venous catheter. Later, due to patient preference, a Tenckhoff catheter was inserted. Conversion to PD occurred 3 weeks later, during hospitalization for a presumed central line infection. A month later, the patient was hospitalized for neutropenic fever. He was diagnosed an acute parvovirus infection and was discharged under isoniazid for latent tuberculosis. Four months later, the patient presented with fever and a cloudy effluent. Peritoneal fluid (PF) cytology was suggestive of infectious peritonitis, but the symptoms persisted despite antibiotic therapy. Bacterial and mycological cultures were negative. No neoplastic cells were detected. Mycobacterium tuberculosis eventually grew in PF cultures, despite previous negative molecular tests. Directed therapy was then initiated with excellent response. Thus, facing a cloudy effluent, one must consider multiple aetiologies. Diagnosis of peritoneal tuberculosis is hampered by the lack of highly sensitive and specific exams. Here, diagnosis was only possible due to positive mycobacterial cultures.
Substances chimiques
Anti-Bacterial Agents
0
Dialysis Solutions
0
Types de publication
Case Reports
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
83-88Informations de copyright
© 2020 Wiley Periodicals LLC.
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