Presented with central nervous system involvement, extra- pulmonary and intra-pulmonary tuberculosis combined infection in a dialysis patient

The clinical appearance of Mycobacterium tuberculosis (TB) in patients on dialysis are substantially non-specific that makes diagnosis difficult. We report a case of extrapulmonary and intrapulmonary TB in end stage renal disease (ESRD). A 58- year-old female with ESRD was admitted to emergency with the complaints of intermittent fever, weakness, impairment of consciousness for last three days. Because of mental confusion she was entubated, transferred to the intensive care unit. Thorax CT showed widespreadcentryasinarnodules in both lungs. The empirically anti-TB therapy was initiated. There was in size of 4x5 cm palpable lymphadenopaty on left supraclavicular region, excisional biopsy revealed caseating granulomatous lymphadenitis. Lumbar puncture was performed and analysis was consistent with TB meningitis. The patient was diagnosed as miliary TB, TB meningitis and TB lymphadenitis and died on the tenth day on admission. Increased awareness of TB in the ESRD population, early diagnosis and treatment are very important.