Unusual Case of Tuberculosis in Hemodialysis Patient-Tuberculoma Involving Right Atrium / 대한신장학회잡지

ABSTRACT

There is a high incidence of tuberculosis in patients with chronic renal failure undergoing hemodialysis. Clinical features and laboratory findings are intermittent high fever of unknown origin, weight loss, high ESR and CRP. The diagnosis of tuberculosis in patients with hemodialysis can be difficult due to non specific symptoms, insidious onset, and unusually high frequency of extrapulmonary involvement. Sites of extrapulmonary involvement include mediastinum, meninges, pleura, kidney, peritoneum, and rarely pericardium. We experienced a unusual case of tuberculoma involving the right atrium in a hemodialysis patient. Our initial impression of this case was pericardial effusion. However, chest CT and echocardiography revealed a mass on the right atrium. Exploratory thoracotomy revealed tuberculous granuloma scattered throughout pericardium and tuberculoma involving right atrium. Following the administration of anti Tbc medication, clinical symptoms and signs resolved and follow up chest CT showed significant decrease in the size of the tuberculoma.