PULMONARY TUBERCULOSIS IN HEMODIALYSIS PATIENTS: A REPORT OF THREE CASES

 

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PULMONARY TUBERCULOSIS IN HEMODIALYSIS PATIENTS: A REPORT OF THREE CASES

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Shuji
Gotoh
Shuji Gotoh shuji051031@icloud.com Daido hospital nephrology Nagoya Japan *
Hideaki Shimizu hshshs34@gmail.com Daido hospital nephrology Nagoya Japan -
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Patients undergoing long-term hemodialysis are at increased risk of developing tuberculosis (TB) due to impaired cellular immunity and multiple comorbidities. We report three cases of pulmonary tuberculosis in chronic hemodialysis patients who achieved favorable outcomes following antituberculous therapy.

Case 1:

A 75-year-old woman with end-stage renal disease (ESRD) secondary to diabetic nephropathy had been on hemodialysis for nine years. Five months before admission, she was treated with prednisolone for interstitial pneumonia. Initial tests showed no acid-fast bacilli; however, three months before admission, a T-SPOT test was positive. Isoniazid (INH) and rifampicin (RFP) therapy was started but could not be continued. One week before admission, she developed fever. Subsequently, miliary nodules appeared in the lungs, and Mycobacterium tuberculosis was detected in both sputum and bone marrow.


Case 2:

An 83-year-old man with ESRD due to diabetic nephropathy had been on hemodialysis for 6 years and 9 months. Eight weeks before admission, he developed fever and impaired consciousness. He was treated for community-acquired pneumonia, and Mycobacterium tuberculosis was detected by sputum.

Case 3:

An 84-year-old man with ESRD secondary to chronic glomerulonephritis had been on hemodialysis for 20 years. Six months before admission, he was hospitalized for pleuritis. A T-SPOT test was positive, but three serial sputum smears were negative. Five days before admission, he developed a fever. Three days before admission, sputum was positive for M. tuberculosis.

All three hemodialysis patients had pulmonary involvement without a prior history of TB. The causes of fever in hemodialysis patients are diverse, and the diagnosis of tuberculosis required considerable time. Antituberculous therapy was initiated in all cases, resulting in clinical improvement without severe complications.

Tuberculosis in hemodialysis patients is often difficult to diagnose and frequently recognized only after the onset of symptoms. Given their atypical clinical presentations and impaired immune responses, clinicians should maintain a high index of suspicion and perform early diagnostic evaluations to improve patient outcomes.

Kewords