Extrapulmonary tuberculosis in patients with end stage renal disease

Chronic renal failure is a risk factor fortuberculosis. In the past five years we have identifiedtwo cases of tuberculosis in our dialysis population.The first patient, showed chronic failure to thrive onhemodialysis. An enlarged cervical lymph node wasbiopsied and, although no acid fast bacilli (AFB) wereseen, a culture grew Mycobacterium tuberculosum (TB). Her chest X-ray did not show evidence of pasttuberculosis. The second patient was a long timesmoker who presented with an enlarged cervical node,which was biopsied. AFB were not seen on her biopsy,but her culture grew TB. Extrapulmonary TB is commonin patients with ESRD, and lymph node involvement isthe most common extrapulmonary presentation. Screening with the purified protein derivative (PPD)is not helpful in ESRD patients, since defects in cellmediated immunity are common. A high index ofsuspicion for TB is warranted in patients with ESRD. This revised version was published online in August 2006 with corrections to the Cover Date.