Extrapulmonary tuberculosis in patients with end stage renal disease--two case reports and a brief review

Chronic renal failure is a risk factor for tuberculosis. In the past five years we have identified two cases of tuberculosis in our dialysis population. The first patient, showed chronic failure to thrive on hemodialysis. An enlarged cervical lymph node was biopsied and, although no acid fast bacilli (AFB) were seen, a culture grew Mycobacterium tuberculosum (TB). Her chest X-ray did not show evidence of past tuberculosis. The second patient was a long time smoker who presented with an enlarged cervical node, which was biopsied. AFB were not seen on her biopsy, but her culture grew TB. Extrapulmonary TB is common in patients with ESRD, and lymph node involvement is the most common extrapulmonary presentation. Screening with the purified protein derivative (PPD) is not helpful in ESRD patients, since defects in cell mediated immunity are common. A high index of suspicion for TB is warranted in patients with ESRD.