Abstract
To elucidate the clinical features, diagnosis and treatment efficacy, we examined 8 patients with tuberculosis receiving maintenance hemodialysis in our hospital and affiliated institutions. This study involved three males and five females aged 28 to 72 (59.6±4.9) years. Pulmonary tuberculosis was detected in two patients and extrapulmonary tuberculosis in six (peritonitis, neck lymphadenitis, pericarditis, spondylitis, intestinal tuberculosis). Four of six patients with extrapulmonary tuberculosis had old pulmonary lesions. The duration from initiation of hemodialysis to onset of tuberculosis was significantly shorter in the diabetic group (n=4) than in the non-diabetic group (6.5±4.0 vs 108±67.1 months; p<0.05). Mycobacterium tuberculosis could be demonstrated in only one patient by culture and polymerase chain reaction (PCR) examination. The other patients had been diagnosed as having tuberculosis based on treatment response and diagnostic imaging or biopsy findings. All patients were successfully treated with anti-tuberculosis drugs; two patients with pulmonary tuberculosis received three drugs (isoniazid, INH; rifampicin, RFP; streptomycin, SM), six with extrapulmonary tuberculosis received INH and RFP. These findings suggest that the incidence of extrapulmonary tuberculosis in hemodialysis patients is high and the onset of tuberculosis in diabetic patients is frequently simultaneous with starting dialysis therapy. Therapeutic diagnosis may be needed in dialysis patients suspected of tuberculosis infection, because it is difficult to detect Mycobacterium tuberculosis by culture or PCR.
