투석 환자에서의 결핵의 임상상

Abstract

Background : A retrospective study of the clinical features of tuberculosis in patients undergoing maintenance dialysis was performed. Methods : We reviewed medical records of patients. Results : Among thirty-four patients, fourteen were on hemodialysis and twenty were on peritoneal dialysis. Mean age was 52.4±13.8 years, and interval between initiation of dialysis and onset of tuberculosis ranged from 1 to 146 months. There were 14 cases of pulmonary tuberculosis, 10 cases of tuberculous lymphadenitis, 4 cased of tuberculous peritionitis, 3 cases of miliary tuberculosis, 1 case of spinal tuberculosis, 1 case of tuberculosis of thigh. Patients with pulmonary tuberculosis usually presented with dyspnea and malaise. But typical symptoms of tuberculosis such as fever, cough, sputum, and weight loss were rarely observed. Leukocytosis was absent but anemia, hypoalbuminemia and significant increase in acute phase reactants such as ferritin and C-reactive protein was obvious. Diagnosis was established by positive AFB in 3 patients, and in cases of extrapulmonaty tuberculosis, 13 among 20 patients were diagnosed by typical histologic characteristics on a tissue biopsy. Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and occasionlly ethambutol. And in several cases, incision and drainage, pericardiocentesis, or removal of peritoneal catheter were performed. Among the patients, just one recurrence was observed and four patients died while on antituberculous treatment. Conclusion : In dialysis patients, extrapulmonary tuberculosis is common and diagnosis of tuberculosis is difficult for its atypical manifestations. Therefore, early diagnosis and prompt initiation of treatment is needed in patients with high suspicion of tuberculosis.