Abstract
A woman in her 80s undergoing peritoneal dialysis presented to our hospital with diarrhea and vomiting. She exhibited systemic symptoms such as decreased appetite and leg edema, leading to an emergency admission with suspected infectious enteritis and peritonitis. Blood cultures and samples of continuous ambulatory peritoneal dialysis (CAPD) effluent were submitted, but no pathogens were detected. Because the inflammatory response persisted and antimicrobial therapy did not improve symptoms, blood cultures and CAPD effluent were again submitted, but were negative for culture. However, fully automated analyzer of formed elements in urine (UF-5000) detected bacteria in the same CAPD effluent, raising suspicion of mycobacterial infection. Acid-fast staining was performed and was positive. Additionally, Mycobacterium tuberculosis gene testing using loop-mediated isothermal amplification was positive, confirming the presence of M. tuberculosis. Further testing of submitted gastric juice also detected M. tuberculosis, leading to a diagnosis of tuberculous peritonitis and pulmonary tuberculosis. Mycobacteria are difficult to stain with Gram staining and require a lengthy culture process. Without noticing the discrepancy between the UF-5000 results and bacterial culture results, it is highly likely that M. tuberculosis would not have been detected. This case highlights the importance of interdepartmental collaboration in contributing to pathogen detection and diagnosis.
