Case 3-2013 "Tuberculous peritonitis"

"A 72-Year-Old Woman with Abdominal Pain and Distention after Peritoneal Dialysis", a CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL by David Steele and colleagues.
A 72-year-old woman from Southeast Asia with end-stage renal disease was admitted to the hospital because of nausea, vomiting, and abdominal pain and distention. She had been receiving peritoneal dialysis, reportedly had had multiple episodes of peritonitis, and had recently switched to hemodialysis. During the next few weeks, nausea and vomiting developed and were associated with an unspecified loss of weight. Seventeen days before admission, the patient was evaluated for removal of the peritoneal catheter and for creation of an arteriovenous fistula. While the patient was awaiting surgery, abdominal discomfort and constipation developed, nausea worsened, and the frequency of vomiting increased. On current examination, the patient was drowsy but easily aroused, and she answered questions slowly.
Patients with peritonitis occurring in the context of peritoneal dialysis usually present with the onset of systemic and abdominal symptoms. This patient had had pain and systemic symptoms for several weeks. She was no longer receiving peritoneal dialysis. The physicians were not able to determine the location of the pain. The white-cell count was normal in the peripheral blood but was elevated in the peritoneal fluid. Although these findings are suggestive of peritonitis, they could be due to either an infectious or a noninfectious cause. [Original Article]