Tuberculosis in chronic hemodialysis patients. A review of 9 cases

Tuberculosis is often atypical and therefore difficult to confirm in patien ts on chronic hemodialysis. The objective of this study was to delineate th e clinical picture, investigation results, and management in nine cases of tuberculosis seen between 1987 and 1997 among 74 patients on chronic hemodi alysis. There were five men and four women with a mean age of 51 years (ran ge, 20-78 years). Sixty-six percent of patients had involvement of extrapul monary sites (lymphadenopathy, pericarditis, pleuritis, or meningitis). Fev er was the presenting symptom in 66% of cases. The intradermal tuberculin t est was positive in three of five cases. Chest radiograph findings consiste d in suggestive parenchymal changes in three cases, pleural effusion in one case, and cardiac shadow enlargement in two case. In one patient, the lumb ar tap was of assistance in diagnosing tuberculous meningitis. Efforts to r ecover the tubercle bacillus in the fluid samples failed. Serological tests for tuberculosis were positive in one of two patients. Histologic findings confirmed the diagnosis in the two patients with lymph node involvement. I n the remaining patients, the diagnosis was established based on a favorabl e response to antituberculous therapy. A full recovery was achieved in 88% of patients. Tuberculosis should be considered in chronic hemodialysis pati ents with unsatisfactorily explained symptoms. The investigations capable o f providing the diagnosis should be performed, and antituberculous therapy should be given at the slightest doubt since recovery is largely dependent on prompt treatment.