Cocoon-like fibroadhesive tuberculous peritonitis in a peritoneal dialysis patient.

Tuberculous peritonitis is a devastating complication of peritoneal dialysis (PD). Presentations of tuberculous peritonitis range from the common wet ascitic form to the rare fibroadhesive form, which is clinically indistinguishable from encapsulating peritoneal sclerosis. We describe a 76-year-old man on continuous ambulatory PD for three months developing wet ascitic form of tuberculous peritonitis. Three weeks after institution of antituberculous therapy and removal of PD catheter, his abdominal pain recurred and an encapsulating peritoneal sclerosis-like intestinal obstruction was noted. A rare fibroadhesive form of tuberculous peritonitis associated with the paradoxical response to antituberculous therapy was considered by excluding noncompliance, drug resistance and adverse effects, and other concomitant infections. After surgical enterolysis and continuation of antituberculous treatment, he recovered uneventfully. Our case might be the first report regarding paradoxical deterioration to antituberculous treatment in dialysis patients.