Mousson C, Bonnin A, Dumas M, Chevet D, Rifle G
Service de Néphrologie-Réanimation, Centre Hospitalier Universitaire, Dijon.
Nephrologie. 1993;14(3):139-42.
Depressed immunity in uremic patients increases by ten the risk of tuberculosis. In such patients, 40% of tuberculosis manifestations are extrapulmonary, and peritoneum is involved in about 6% of the cases. Seventeen cases of peritoneal tuberculosis have been so far reported in CAPD patients, and we add a new case. The prognosis of the disease is severe since 8 patients died. Three deaths out of 8 are directly linked to tuberculosis. Indeed, peritoneal tuberculosis diagnosis is hard and often late, at least for two main reasons: at first, it can be difficult to exclude the other causes of lymphocytic peritonitis (viral, fungal, bacterial, etc.), secondly, growth of mycobacteria in dialysate effluent cultures is late and inconstant. Omental biopsy in lymphocytic peritonitis of unknown origin could be of great value for an early diagnosis. Despite the adaptation of antituberculous drugs doses, side-effects are not so rare: optical neuritis and liver toxicity in our case. In spite of ultrafiltration loss, stopping CAPD is not always necessary, as in the reported case.
尿毒症患者免疫力低下使患结核病的风险增加了十倍。在这类患者中，40%的结核表现为肺外结核，约6%的病例累及腹膜。迄今为止，已有17例腹膜结核病例在持续性非卧床腹膜透析（CAPD）患者中被报道，我们新增了1例。由于8名患者死亡，该病的预后很严重。8例死亡中有3例直接与结核病相关。事实上，腹膜结核的诊断很困难且往往较晚，至少有两个主要原因：首先，很难排除淋巴细胞性腹膜炎的其他病因（病毒、真菌、细菌等）；其次，结核分枝杆菌在透析液流出物培养中的生长较晚且不稳定。对不明原因的淋巴细胞性腹膜炎进行网膜活检可能对早期诊断有很大价值。尽管调整了抗结核药物剂量，但副作用并不罕见：在我们的病例中出现了视神经炎和肝毒性。尽管存在超滤损失，但并不总是需要停止CAPD，如报道的病例所示。
