Nhân một trường hợp viêm phúc mạc do lao trên trẻ thẩm phân phúc mạc liên tục ngoại trú

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Tác giả: Thị Phượng Lương, Thu Hương Nguyễn

Ngôn ngữ: Vie

Ký hiệu phân loại: 618.92 Pediatrics

Thông tin xuất bản: Tạp chí Nghiên cứu Y học, 2020

Mô tả vật lý: 172-176

Bộ sưu tập: Metadata

ID: 417664

Thêm vào giỏ Liên kết toàn văn

Viêm phúc mạc là một trong những biến chứng hay gặp của thẩm phân phúc mạc liên tục ngoại trú (CAPD). Biểu hiện lâm sàng của viêm phúc mạc do lao thường rất khó phân biệt với vi khuẩn. Chúng tôi báo cáo trẻ nam 17 tuổi bệnh thận mạn giai đoạn cuối đang thực hiện CAPD, có tiền sử 3 lần viêm phúc mạc, cấy vi khuẩn đều âm tính. Đợt này trẻ bị viêm phúc mạc lần thứ 4. Trẻ vào viện trong tình trạng suy kiệt, đau bụng, sốt, dịch màng bụng đục, bạch cầu máu, CRP tăng, tế bào dịch màng bụng 186/µl trong đó 60% là tế bào đa nhân trung tính, cấy vi khuẩn và nấm dịch màng bụng đều âm tính. Sau 7 ngày điều trị kháng sinh bao phủ gram âm, gram dương và nấm lâm sàng không cải thiện. Chúng tôi nghĩ trẻ có thể viêm phúc mạc do lao và xét nghiệm PCR lao dịch màng bụng và quantiFERON cho kết quả dương tính. Trẻ được rút catheter thẩm phân, chuyển thận nhân tạo chu kỳ và điều trị lao, trẻ hết sốt, hết đau bụng, CRP giảm. , Tóm tắt tiếng anh, Peritonitis is one of the major complications of continuous ambulatory peritoneal dialysis (CAPD). Clinical manifestations of tuberculous peritonitis typically are usually indistinguishable from bacterial peritonitis. We report a case of a 17-year-old boy who suffered from end-stage renal disease with a history of 3 times of peritonitis with negative peritoneal effluent cultures. He was admitted to my hospital in a state of exhaustion, abdominal pain, fever, and cloudy effluent. Both White blood cells and CRP levels are elevated. Effluent white blood count was 186/µl with 60% neutrophils. Peritoneal effluent bacterial and fungi cultures were all negative. He was treated with antibiotics for grampositive, gram-negative coverage and fungal for 7 days but his symptoms remained unchanged. We thought he might be suffered from tuberculous peritonitis. We decided to perform the mycobacterial tuberculosis PCR of the peritoneal effluent and quantiFERON test. The result was positive. The patient was diagnosed with peritoneal tuberculosis/CAPD and was treated with antibiotics specific for tuberculosis
subsequently, the patient showed clinical and laboratory improvement.

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