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[A case report on tuberculosis with remittent fever after tonsillectomy in a patient under CAPD]
S Kawai1, H Hirano, Y Watanabe
1Department of Nephrology, Kawasaki Medical School, Okayama, Japan.
Kekkaku : [Tuberculosis]
|December 1, 1991
Summary
A patient on long-term dialysis developed persistent fever after tonsillectomy, later diagnosed with tuberculosis. Early antitubercular treatment resolved the fever, highlighting a crucial diagnostic consideration.
Area of Science:
- Nephrology
- Infectious Diseases
- Otolaryngology
Background:
- Patients undergoing long-term dialysis, such as continuous ambulatory peritoneal dialysis (CAPD), exhibit increased susceptibility to infections, including tuberculosis.
- Post-tonsillectomy fever can present diagnostic challenges, particularly when initial antibiotic therapy is ineffective.
Observation:
- A 45-year-old female on CAPD for five years presented with recurrent fever and cervical lymphadenopathy post-tonsillectomy.
- Despite initial improvement, symptoms recurred, and lymph node biopsy revealed epithelioid cell granuloma with abscess, while acid-fast bacilli cultures were negative.
Findings:
- The patient's persistent, antibiotic-refractory fever resolved within three days of initiating isoniazid (INH) treatment.
- This case represents the first reported instance of tuberculosis presenting with post-tonsillectomy fever in a patient on long-term dialysis.
Implications:
- The findings underscore the importance of considering tuberculosis in dialysis patients with unexplained, persistent fever, especially after surgical procedures.
- Early diagnosis and initiation of antitubercular chemotherapy are recommended for febrile patients with antibiotic-refractory symptoms to prevent diagnostic delays and ensure prompt recovery.