TUBERCULOUS PERITONITIS IN AN ESRD PATIENT ON MAINTENANCE HAEMODIALYSIS - A RARE CASE REPORT

Introduction Hemodialysis remains the major modality of treatment for patients with end stage renal disease. Cardiovascular events and infections are commonly encountered problems in stage V chronic kidney disease patients on long term hemodialysis. Apart from this significant proportion of patients on maintenance hemodialysis develop ascites .The cause of ascites most often due to noncompliance with salt and water, cardiac failure, hepatic vein thrombosis, chronic liver disease, spontaneous bacterial peritonitis and malignancy. Inspite of extensive workup the cause may not be identifiable in a small proportion of patients which is termed as Dialysis associated ascites. The treatment of hemodialysis associated ascites is usually not satisfactory, which consists of improvement in nutrition, search for occult infection and intensification of hemodialysis regimen. Case report A 33 yr old gentleman with history of hypertension and severe end stage renal failure was started on maintenance hemodialysis in June 2011. He was stable till Jan 2014, after which developed pedal edema, progressing ascites and breathing difficulty. He was found to have moderate pulmonary hypertension and left ventricular dysfunction. There was persistent ascites and breathlessness after treatment of cardiac failure and intensification of dialysis. He was evaluated for other causes of ascites and found to have tuberculosis by automated culture for AFB in peritoneal fluid. He showed a gradual reduction in the abdominal girth and ascites over 6 months after starting antituberculous therapy. Conclusion Tuberculous peritonitis is one of the rare presentation of tuberculosis in hemodialysis patients. High index of suspicion is needed and ascites of unknown cause should be thoroughly evaluated.