TUBERCULOUS OSTEOMYELITIS - AN UNUSUAL CASE OF TUBERCULOUS INFECTION IN A CHILD UNDERGOING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

A 10-year-old boy on continuous ambulatory peritoneal dialysis had low -grade fever, pain and tenderness of the right shoulder; he had no his tory of infection or exposure to tuberculosis. The underlying granulom atous infection was diagnosed by histological examination of bone and the polymerase chain reaction with primer sequences specific for Mycob acterium tuberculosis. Special stains and cultures were negative. The initiation of anti-tuberculous therapy was followed by a sharp improve ment in the fever, malaise and shoulder pain within several weeks. Ext rapulmonary tuberculosis is common in patients with chronic renal fail ure on dialysis and the diagnosis is difficult, The clinician must rec ognise the high and early mortality rate in order to initiate an aggre ssive diagnostic approach and early therapy.