Abstract: TH-PO0909
When Positive Cultures Mislead: Tuberculous Pleuroperitonitis in Refractory Peritoneal Dialysis (PD) Peritonitis
Session Information
- Home Dialysis: Utilization Patterns, Complications, and Quality-of-Life Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Pongmanjit, Natphapas, Navamindradhiraj University, Bangkok, Thailand
- Ngamvichchukorn, Tanun, Navamindradhiraj University, Bangkok, Thailand
Introduction
Tuberculous peritonitis is an uncommon but serious cause of PD-related peritonitis. Diagnosis may be delayed when bacterial pathogens are isolated, falsely reassuring clinicians.
Case Description
A 54-year-old man with ESKD on CAPD for 4 months presented with poor dialysate flow from fibrin obstruction, without fever or abdominal pain. PD WBC was 140/µL, 71% neutrophils, and culture grew methicillin-resistant coagulase-negative Staphylococcus. He received intraperitoneal vancomycin. Three days later, he was readmitted with fever, abdominal pain, and cloudy effluent. Repeat PD WBC was 50/µL. Despite continued therapy, follow-up 3 days later showed worsening peritonitis with PD WBC 530/µL, 68% neutrophils, and culture grew carbapenem-resistant Acinetobacter baumannii. He received IV colistin plus meropenem, underwent prompt PD catheter removal, and transitioned to hemodialysis for recurrent and refractory peritonitis. Ten days later, he developed septic shock and persistent ileus. CT showed smooth peritoneal enhancement, omental smudging, small-bowel dilatation, and loculated right pleural effusion. Image-guided drainage revealed marked lymphocyte predominance (WBC 240/µL, 96% lymphocytes). GeneXpert MTB/RIF detected Mycobacterium tuberculosis without rifampicin resistance in ascitic and pleural fluid. Because of ileus and concern for impaired enteral absorption, anti-tuberculous drugs was started with adjunctive IV levofloxacin and amikacin. His fever resolved and clinical status improved.
Discussion
Culture-positive bacterial peritonitis does not exclude concomitant tuberculosis in PD patients. Persistent deterioration despite antibiotics and catheter removal, particularly with peritoneal thickening and pleural effusion, should prompt evaluation for disseminated tuberculosis. Pleuroperitoneal involvement is a key clue to systemic disease. GeneXpert MTB/RIF from ascitic and pleural fluid enables rapid diagnosis. In TB-endemic settings, tuberculosis should be considered in refractory or atypical PD-related peritonitis, even when bacterial cultures are positive.
Picture A: loculated right pleural effusion(arrow) Picture B: smooth peritoneal enhancement(arrow), omental smudging(asterisk)