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Cocoon-like fibroadhesive tuberculous peritonitis in a peritoneal dialysis patient

Wei-Cheng Tseng1, Der-Cherng Tarng

  • 1Department of Medicine, Taitung Veterans Hospital, Taitung, Taiwan, Republic of China.

The Chinese Journal of Physiology
|January 4, 2013
PubMed

Insights

Tuberculous peritonitis is a serious complication for peritoneal dialysis (PD) patients. This case highlights a rare fibroadhesive form and paradoxical worsening despite treatment, emphasizing careful management in dialysis patients.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Tuberculous peritonitis is a severe complication in patients undergoing peritoneal dialysis (PD).
  • It can manifest as wet ascitic or rare fibroadhesive forms, mimicking encapsulating peritoneal sclerosis.
  • Early diagnosis and management are crucial for patient outcomes.

Observation:

  • A 76-year-old male on continuous ambulatory PD presented with wet ascitic tuberculous peritonitis.
  • Following initial treatment and PD catheter removal, he experienced recurrent abdominal pain and intestinal obstruction.
  • Symptoms suggested a fibroadhesive form of tuberculous peritonitis, possibly due to a paradoxical reaction to therapy.

Findings:

  • The patient exhibited a paradoxical deterioration despite antituberculous therapy and PD catheter removal.
  • Exclusion of noncompliance, drug resistance, adverse effects, and other infections supported the paradoxical reaction hypothesis.
  • Surgical enterolysis combined with continued antituberculous treatment led to recovery.

Implications:

  • This case may represent the first report of paradoxical deterioration to antituberculous treatment in a dialysis patient.
  • It underscores the importance of considering rare presentations and paradoxical reactions in managing tuberculous peritonitis in PD patients.
  • Further research into paradoxical reactions in this population is warranted.

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