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Refractory peritoneal dialysis-associated peritonitis caused by Mycobacterium tuberculosis identified by mNGS: a case
Lichun Wang1, Junjie Xu2, Peihua He3
1Department of Nephrology, Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 53 Jida Jingle Road, Xiangzhou District, Zhuhai, Guangdong Province, 519015, China. wanglichun322@163.com.
Background:
Peritoneal dialysis-associated peritonitis (PDAP) is a common complication in patients undergoing peritoneal dialysis (PD) and may lead to technique failure or poor prognosis. Tuberculosis-related peritonitis in this setting is rare and difficult to diagnose because of nonspecific clinical manifestations and frequently negative conventional microbiological tests. Reporting such cases may help improve awareness and diagnostic strategies.
Case Presentation:
We report the case of a 34-year-old woman with systemic lupus erythematosus and end-stage renal disease who was receiving maintenance peritoneal dialysis. She presented with fever, abdominal pain, and diarrhea. Repeated conventional bacterial and fungal cultures of peritoneal dialysis effluent and blood were negative, and empirical antibiotic therapy failed to achieve sustained clinical improvement. Metagenomic next-generation sequencing of the peritoneal dialysis effluent detected Mycobacterium tuberculosis, providing supportive diagnostic information. Based on the combined clinical presentation, molecular findings, and immunological testing, anti-tuberculosis therapy was initiated. The patient's symptoms gradually resolved, and peritoneal dialysis was temporarily suspended for 11 days before being successfully resumed. No recurrence of peritonitis was observed during a 6-month follow-up period.
Conclusions:
This case highlights the diagnostic challenges of tuberculosis-related peritonitis in patients undergoing peritoneal dialysis. Metagenomic next-generation sequencing may serve as a useful adjunctive diagnostic tool in selected patients with persistent symptoms and repeatedly negative conventional cultures, facilitating earlier diagnosis and appropriate management.
Insights
Tuberculosis-related peritonitis is a rare complication in peritoneal dialysis patients. Metagenomic sequencing aided diagnosis when cultures were negative, enabling timely anti-tuberculosis treatment and successful treatment continuation.
Area of Science:
- Nephrology
- Infectious Diseases
- Genomics
Background:
- Peritoneal dialysis-associated peritonitis (PDAP) is a frequent complication of peritoneal dialysis (PD).
- Tuberculosis-related peritonitis (TRP) in PD patients is uncommon, presenting with nonspecific symptoms and often negative conventional diagnostic tests.
- Early diagnosis and management of TRP are crucial to prevent technique failure and improve patient outcomes.
Purpose of the Study:
- To report a case of tuberculosis-related peritonitis in a patient undergoing maintenance peritoneal dialysis.
- To highlight the diagnostic challenges associated with this rare condition.
- To evaluate the utility of metagenomic next-generation sequencing (mNGS) as a diagnostic tool.
Main Methods:
- A case report of a 34-year-old woman with end-stage renal disease on PD is presented.
- The patient exhibited symptoms of fever, abdominal pain, and diarrhea with negative conventional cultures.
- Metagenomic next-generation sequencing of peritoneal dialysis effluent was performed.
Main Results:
- Conventional bacterial and fungal cultures of PD effluent and blood were negative.
- Metagenomic next-generation sequencing identified Mycobacterium tuberculosis in the PD effluent.
- Anti-tuberculosis therapy led to symptom resolution, allowing temporary suspension and subsequent resumption of PD.
Conclusions:
- Tuberculosis-related peritonitis poses significant diagnostic challenges in PD patients.
- Metagenomic next-generation sequencing can be a valuable adjunctive tool for diagnosing TRP when conventional methods fail.
- This molecular technique can facilitate earlier diagnosis and appropriate management, improving outcomes.
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