Fatal hepatic failure caused by miliary tuberculosis in a hemodialysis patient: case report.
Kushihata S. Yorioka N. Nishida Y. Amimoto D. Takasugi T. Taniyama K. Yamakido M.
Hakuai Hospital, Hiroshima, Japan.
A 57 year-old male dialysis patient died soon after the onset of high fever, hypoglycemia, and disturbance of consciousness. Autopsy revealed granulomatous lesions associated with caseous necrosis mainly found in the liver, despite the absence of pulmonary changes on chest radiographs performed during the patients illness. It appears that tubercle bacilli were hematogenously disseminated mainly to the liver causing miliary tuberculosis without producing typical diffuse lesions in the lungs. Since tuberculosis is a common complication in hemodialysis patients, the potential development of atypical miliary tuberculosis should always be borne in mind.
CAPD catheter rupture without deterioration.
Kushihata S. Yorioka N. Ito T. Nishida Y. Amimoto D. Ye XF. Yamakido M.
Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
Continuous ambulatory peritoneal dialysis (CAPD) is associated with various problems, including damage to the CAPD catheter. We encountered catheter rupture around the titanium adaptor in a patient who had been on CAPD for 7 years. The area near the adaptor generally suffers damage secondary to deterioration of the silicon composing the catheter. However, stereoscopic and electron microscopic observation of the surface of the catheter revealed no deterioration. Instead, there were fine scratches around the site of rupture and the broken surface was rough. Since the patient did not protect the catheter with gauze near the titanium adaptor, it was probably damaged by the adaptor and then ruptured by some external force.