Although conventional wisdom advises removal of the Tenckhoff
catheter as part of the
therapy for
tuberculous peritonitis, there are a few recent reports of cases successfully treated while maintaining the patients on
CAPD. We wish to report three cases treated without interrupting
CAPD. In two of the patients, cultures were positive for Mycobacterium tuberculosis and in the third case, although the cultures were negative, the patient improved on anti-Tb medications. Smear for AFB was positive in one patient; and two had a positive
PPD. All had predominance of lymphocytes and monocytes in effluent. The total WBC count was 160-300 and two patients had
fever. All had
abdominal pain. One patient was treated with INH and
ethambutol; one with INH and
rifampin and one (who was suspected of being HIV+) also received
pyrazinamide (PZA) until culture was available. Cultures grew in 4-6 weeks. All were started on
therapy prior to having the culture results, and all showed clinical improvement within two weeks. One patient had his
catheter replaced two months later because of pseudomonas
peritonitis, continued on
CAPD for an additional five months, then changed to HD because of recurrent bacterial
peritonitis. One patient died of complications of
diabetic vascular disease three months later with no evidence of
peritonitis. One patient has remained on anti-Tb treatment for seven months and is doing well on
CAPD.