Abstract
We report a case of tuberculous lymphadenitis in a hemodialysis patient. A 71-year-old male, who had undergone maintenance hemodialysis for diabetic nephropathy, suffered from an A-V fistula occlusion. He received reconstruction of the A-V fistula at the opposite forearm, and he had a fever on the 4th postoperative day. Although we treated him with various antibacterial agents, fever remained for several weeks. A computed tomography (CT) scan revealed several swollen lymph nodes in the left cervical and para-aortic regions, and a blood examination showed a high IL-2R level. According to these results, we suspected malignant lymphoma and performed a left cervical lymph node biopsy. Histopathologic findings indicated caseating granuloma, and it was shown by PCR assay the detection of tubercle bacillus in the specimen; therefore, we made a diagnosis of tuberculous lymphadenitis. Remission was achieved after simultaneous administration of four anti-tuberculous drugs, and left cervical and para-aortic lymph node swelling was not seen in a CT scan one year after treatment. A fever of unknown origin (FUO) is occasionally seen in patients receiving hemodialysis. Tuberculosis may be the cause of the FUO, so it should be considered in differential diagnosis in these patients.
