Objectives: To report a case of tuberculous peritonitis with positive Ziehl-Neelsen staining of the peritoneal ?uid in children with chronic kidney disease (CKD) on continuous ambulatory peritoneal dialysis (CAPD). This case was never been reported before in Ulin Hospital, Banjarmasin.
Case: A sixteen years old girl was diagnosed CKD stage V with renal polycystic since 1 year ago. She underwent the hemodialysis for the first 6 months and CAPD for the last 6 months. She was presented with chronic cough, no abdominal complaints, cloudy dialysate fluid and the CAPD was not functioning effectively which shown by increasing urea and creatinine. No sign of infection in CAPD exit site. The Ziehl–Neelsen staining in sputum showed there were no M.Tb. Chest X-ray was not suggestive of M.Tb infection. Peritoneal fluid analysis was performed. It shown a positive acid fast bacilli, no Gram bacteria and the leucocyte was 1023/ul with polymorphonuclear predominantly. The GeneXpert examination shown that the Mycobacterium tuberculosis was high detected in peritoneal fluid and low-detected in sputum. Patient was given the steroid and injectable anti-TB drug due to upper GI bleeding (dose was adjusted for renal failure) then switch to oral anti-TB after the enteral feeding was tolerated. Peritoneal fluid analysis was evaluated and showed an improvement at day 21st anti-TB drug (no acid fast bacilli nor Gram bacteria, leucocyte was 428/ul).
Conclusions: Tuberculous peritonitis is an uncommon extrapulmonary form of Mycobacterium tuberculosis infection, frequently presenting with nonspecific and insidious symptoms. Ziehl-Neelsen staining of the peritoneal ?uid for mycobacterial detection is positive in only about 3% of the cases Diagnosis is therefore difficult, unsuspected, and often delayed, especially in the pediatric patient without an obvious history of exposure to the pathogen. Therefore, clinicians should be aware of the disease for the early diagnosis.