Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review. Clin Infect Dis 2000;31:70–5

A case of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) in a 37-year-old man who presented with fever, abdominal pain, and a malfunctioning Tenckhoff catheter is reported. The patient was initially treated for presumed bacterial per-itonitis but remained febrile and had persistent abdominal pain and peritoneal ¯uid pleocy-tosis, despite broad-spectrum antibiotic therapy. Mycobacterium tuberculosis was isolated in a culture of peritoneal ¯uid, and the patient responded promptly to antituberculous therapy. More than 50 cases of tuberculous peritonitis complicating CAPD that have been reported in the English-language literature since the initial case was reported in 1980 are reviewed. The most common symptoms are fever (78%), abdominal pain (92%), and cloudy dialysate (90%); 76 % of cases had a predominance of polymorphonuclear cells in peritoneal ¯uid. A smear for acid-fast bacilli or a culture was positive in 73 % of cases. The peritoneal dialysis catheter was removed in 53 % of cases, although this was rarely considered necessary for cure of tuberculosis. The attributable mortality rate is 15%, with the most signi®cant factor being treatment delay (mean time from presentation to initiation of treatment, 6.74 weeks). We conclude that tu-berculosis is an important diagnostic consideration for CAPD patients with peritonitis tha