Peritoneal Tuberculosis In A Hemodialysis Patient With Longstanding Ascites: A Diagnostic Challenge

Abstract

Introduction: Tuberculous peritonitis is an uncommon form of extrapulmonary tuberculosis that is difficult to diagnose in patients receiving maintenance dialysis because its clinical manifestations are often nonspecific and overlap with nephrogenic ascites or fluid overload. Delayed diagnosis may postpone appropriate treatment and worsen clinical outcomes.

Case: We report the case of a 44-year-old man with end-stage renal disease on maintenance hemodialysis who presented with persistent ascites. The condition was initially considered nephrogenic ascites, but the subsequent development of constitutional symptoms prompted further evaluation. Ascitic fluid analysis and additional investigations confirmed the diagnosis of tuberculous peritonitis, and antituberculous therapy was initiated.

Discussion: This case illustrates the diagnostic challenge of distinguishing tuberculous peritonitis from other causes of ascites in dialysis patients. Persistent ascites that does not improve with optimized dialysis should prompt consideration of infectious etiologies, particularly tuberculosis in endemic settings. Early diagnostic workup is crucial for timely treatment.

Conclusion: Tuberculous peritonitis should be included in the differential diagnosis of refractory ascites in patients undergoing maintenance dialysis. Early recognition and prompt investigation can facilitate timely treatment and improve patient outcomes.