Increasing serum calcium levels and recent return from transplantation as clues to the tuberculous nature of refractory peritoneal dialysis peritonitis.
Peritoneal tuberculosis is an uncommon complication of peritoneal dialysis in Europe. It is more common in Asian immigrants. A delayed diagnosis is frequent and impairs patient outcomes. We present two cases of peritoneal tuberculosis with common features that may help suspect the disease early countries with a low incidence. Both patients were females (of Spanish origin) who had recently restarted peritoneal dialysis following kidney transplantation. Both developed bacterial peritonitis clinically that was refractory to conventional antibiotics, despite clearance of bacteria. Both stopped calcium-containing phosphate binders because of increasing serum calcium that in one case led to frank hypercalcemia that persisted despite low calcium dialysate. Peritoneal biopsy was the first positive test in both cases. This report emphasizes the recent return from transplantation and rising serum calcium levels as features that should alert the physician of a potential underlying tuberculous peritonitis.
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Rodriguez-Osorio
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Fernandez-Fernandez
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Martin-Cleary
Department of Nephrology, Biomedical Research Institute IIS-Foundation Jimenez Diaz/Autonomous University of Madrid, Renal Research Institute Queen Sofia (IRSIN) and Kidney Research Network REDINREN, Madrid, Spain.
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Ortiz
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002118:Calcium / Q000032:analysis / Q000097:blood*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010530:Peritoneal Dialysis; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome
D000995:Antitubercular Agents; D002118:Calcium