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TUBERCULOUS PERITONITIS IN DIFFERENT DIALYSIS PATIENTS IN SOUTHERN TAIWAN

Eleven cases of tuberculous peritonitis (TBP) in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients at the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan between 1991 and 2000 were studied retrospectively (six cases in the HD group and five cases in the CAPD group) The diagnosis of TBP was established by either positive ascite tuberculosis (TB) culture or biopsy-proven chronic granulomatous inflammation. Fever and abdominal pain were the most common symptoms, while leukocytosis and unexplained hypercalcemia were the most common laboratory findings. Ascite analysis showed a lymphocyte predominance in all HD patients, but in only 40% of the CAPD patients. The mean duration of a diagnosis by ascite TB cultures was six weeks, while a diagnosis confirmed by laparascopic biopsy took one week. All four fatal cases were diagnosed by TB cultures. Laparoscopic biopsy provided a rapid diagnosis and resulted in low morbidity and mortality in our patients. Based on our review of all possible abstracts found in a Medline search from 1966 to 2002 using the keywords tuberculosis, peritonitis, uremia, and dialysis, this may be the first study of TBP in different dialysis patients.

Received September 3, 2003. Accepted for publication December 31, 2003.

Acknowledgment: This work was presented in part (as an abstract) at the 20th Annual Conference on Peritoneal Dialysis, San Francisco, CA, February 2000.

Authors’ addresses: Yao-Min Hung and Hsiao-Min Chung, Division of Nephrology, Kaohsiung Veterans General Hospital, 41 Chiouting Road, Kaohsiung 80043, Taiwan, Telephone: 886-7-342-2121 extension 2050, Fax: 886-7-345-5412, E-mail: ymhung1{at}doctor.com and National Yang Ming University, School of Medicine, Taipei, Taiwan. Hoi-Hung Chan, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.