Tuberculous Pyomyositis in a Renal Transplant Patient / 대한신장학회잡지

Tuberculosis infection of skeletal muscle is rare, even in countries where tuberculosis is relatively prevalent. Because tuberculosis of muscle is usually secondary to underlying tuberculosis of the bone or adjacent joint, isolated tuberculosis of skeletal muscle is very rare. Moreover, tuberculosis pyomysitis shows nonspecific symptoms even in immuno-compromised hosts. Recently we experienced an isolated tuberculosis pyomysitis in renal allograft recipient and report here. A 57-year-old woman presented with pain and edema on right calf area. Sonographic imaging of right calf muscle showed large elongated fluid collection. Operative debridement was done and the histopathology of calf muscle showed granulomas surrounded by Langhans' giant cells. We diagnosed her as tuberculous polymyositis combining the data of histology and positive result of polymerase chain reaction for mycobacterium tuberculosis. We treated her with the anti-tuberculosis medication. After surgical debridement and medical management, calf muscle tuberculous polymyositis showed fair improvement.

Clinical Outcomes of Gram-negative Bacterial Peritonitis / 대한신장학회잡지

BACKGROUND: Peritonitis which is still the most important cause of morbidity and technical failure in peritoneal dialysis even though it has decreased significantly, has been known to lead to different outcomes by the type of causative pathogens. METHODS: To analyze clinical outcomes with trends of peritonitis rates by the type of causative pathogens, we retrospectively reviewed peritoneal dialysis patients in Seoul National University Hospital from 1995 to 2001. RESULTS: Three hundred fifty-seven cases of peritonitis occurred in 163 patients among total 307 peritoneal dialysis patients and the rate of peritonitis was 0.44 episodes/patient-year. There are 130 (38.1 %) episodes of Gram-positive bacterial peritonitis, 59 (17.3%) episodes of Gram-negative bacterial peritonitis and 25 (7.3%) episodes of mixed bacterial peritonitis. E.coli, Acinetobacter, and Pseudomonas were main Gram-negative isolates, in the order named. The rate of total peritonitis and the rate of Gram- positive peritonitis decreased significantly during the study period. But, the rate of Gram-negative peritonitis remained constant, and therefore its relative proportion tended to increase. Among Gram-negative bacteria, the proportion of Pseudomonas species declined persistently. Gram-negative peritonitis was a significant risk factor of hospitalization, independent of soft tissue infection and serum albumin, like S.aureus peritonitis. In Gram-negative peritonitis or Pseudomonas peritonitis, more catheters were removed regardless of soft tissue infection or peritoneal dialysis duration. CONCLUSION: In conclusion, we confirmed Gram- negative peritonitis and Pseudomonas peritonitis have poor prognosis. Therefore, Cautious evaluation of abdominal lesions and aggressive treatment are necessary for patients with Gram-negative peritonitis whose relative proportion increased.