Tuberculous peritonitis in patients undergoing chronic home peritoneal dialysis

Peritonitis is a well-recognized complication of chronic peritoneal dialysis. However, in many instances the etiology of the peritonitis remains obscure despite intensive evaluation. Recent reports have suggested that pulmonary and extrapulmonary tuberculosis occurs with increased incidence in chronic hemodialysis patients. We report the first three cases of tuberculous peritonitis occurring in patients being treated with chronic intermittent peritoneal dialysis. The lack of active tuberculosis elsewhere and the predominance of polymorphonuclear leukocytes in peritoneal fluid made the diagnosis particularly difficult in this setting. The characteristics of the peritoneal fluid are quite similar to that seen in bacterial peritonitis, and unlike that found in peritonitis due to tuberculosis in nondialyzed patients. Tuberculous peritonitis should be suspected in peritoneal dialysis patients with chronic or relapsing peritonitis in whom the diagnosis of bacterial or fungal peritonitis cannot be confirmed.