Laparoscopic peritoneal biopsy for the diagnosis of tuberculous peritonitis in a peritoneal dialysis patient

Peritoneal tuberculosis is a rare but a severe disease in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A 60 years old male, who had been the CAPD program during the last 5 months, was admitted to our clinic with fever, loss of appetite, night sweats, cough, weight loss and cloudy dialysate. Mycobacteria cultures of blood and pleural fluid were sterile. Bacterial cultures of peritoneal fluid were also sterile. The patient was initially treated for presumed bacterial peritonitis but remained febrile and also the dialysate remained cloudy. Laparoscopic peritoneal biopsy was performed. The peritoneal biopsy revealed giant cell granulomas formed by lymphocytes, histiocytes and Langerhans cells.Triple anti-tuberculous treatment was started. In this case tuberculosis peritonitis was successfully treated without interruption of dialysis and removal of the peritoneal dialysis catheter. We concluded that laparoscopic biopsy can be applied to the patients with persistent culture negative peritonitis.