Case Report: A case of refractory tuberculous peritonitis mimicking and complicating suspected encapsulating peritoneal sclerosis in a long-term peritoneal dialysis patient

Key findings from this study

This research indicates that:

• Tuberculous peritonitis can clinically and radiologically mimic encapsulating peritoneal sclerosis in long-term peritoneal dialysis patients, delaying diagnosis
• Metagenomic next-generation sequencing identified Mycobacterium tuberculosis complex when conventional microbiological and imaging approaches suggested alternative peritoneal pathology
• Combined catheter removal and renal-adjusted anti-tuberculous therapy (levofloxacin and linezolid) resulted in clinical and biochemical improvement

Overview

Tuberculous peritonitis (TBP) presented as a diagnostic challenge in a 59-year-old male on chronic peritoneal dialysis, manifesting with clinical and radiological features overlapping with encapsulating peritoneal sclerosis (EPS). The case demonstrates diagnostic complexity when TBP complicates pre-existing peritoneal pathology and highlights the role of molecular diagnostics in resolving ambiguous presentations.

Methods and approach

Clinical evaluation combined contrast-enhanced CT imaging with peritoneal fluid analysis. Metagenomic next-generation sequencing (mNGS) of peritoneal fluid identified the causative organism when conventional antimicrobial therapy failed. Management proceeded with laparoscopic catheter removal, hemodialysis transition, and renal-adjusted anti-tuberculous therapy.

Results

The patient experienced recurrent abdominal pain, fever, and cloudy effluent following prior Staphylococcus caprae peritonitis. Initial CT revealed diffuse peritoneal thickening, omental caking, and localized ascites suggestive of EPS. Persistent symptoms despite broad-spectrum antibiotic coverage prompted mNGS analysis, which definitively identified Mycobacterium tuberculosis complex. The secondary inflammatory changes induced by tuberculosis mimicked radiological and clinical features characteristic of EPS, creating diagnostic confusion. Following catheter removal and initiation of anti-tuberculous therapy with levofloxacin and linezolid, the patient achieved gradual clinical and biochemical improvement.

Implications

TBP represents a potentially overlooked diagnosis in long-term PD patients, particularly when pre-existing peritoneal pathology suggests alternative diagnoses. The similarity between inflammatory changes associated with TBP and structural peritoneal sclerosis necessitates heightened clinical suspicion when clinical deterioration occurs despite antimicrobial therapy. Molecular diagnostic approaches such as mNGS provide definitive pathogen identification in complex peritoneal infections and warrant integration into diagnostic algorithms when conventional methods prove inconclusive.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.