{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T06:19:05Z","timestamp":1775110745536,"version":"3.50.1"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculous peritonitis (TBP) is a rare but severe complication in peritoneal dialysis (PD) patients, often presenting with non-specific symptoms. Its diagnosis is particularly challenging in patients with pre-existing or co-existing peritoneal pathology, such as changes suggestive of encapsulating peritoneal sclerosis (EPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 59-year-old male on PD for 14\u202fyears with no prior history of peritonitis presented with recurrent abdominal pain, fever, and cloudy effluent, following a recent episode of\n                      <jats:italic>Staphylococcus caprae<\/jats:italic>\n                      peritonitis. Initial contrast-enhanced computed tomography (CT) revealed diffuse peritoneal thickening, omental \u201ccaking,\u201d and localized ascites, raising strong suspicion for EPS. However, the patient\u2019s condition relapsed despite broad-spectrum antibiotic therapy. Metagenomic next-generation sequencing (mNGS) of peritoneal fluid definitively identified\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      complex. The diagnosis was thus revised to TBP manifesting with secondary peritoneal inflammatory changes mimicking EPS. Management involved laparoscopic PD catheter removal, transition to hemodialysis, and initiation of a renal-adjusted anti-tuberculous regimen (levofloxacin and linezolid), leading to gradual clinical and biochemical improvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that TBP can clinically and radiologically mimic EPS in long-term PD patients, leading to diagnostic delay. High clinical suspicion and the utilization of advanced molecular diagnostics like mNGS are crucial for accurate diagnosis. Catheter removal combined with appropriate anti-tuberculous therapy forms the cornerstone of management in such complex scenarios.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1777805","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:25:34Z","timestamp":1775107534000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A case of refractory tuberculous peritonitis mimicking and complicating suspected encapsulating peritoneal sclerosis in a long-term peritoneal dialysis patient"],"prefix":"10.3389","volume":"13","author":[{"given":"Tianjiao","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingcheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1177\/08968608221080586","article-title":"ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment","volume":"42","author":"Li","year":"2022","journal-title":"Perit Dial Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1086\/313919","article-title":"Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review","volume":"31","author":"Talwani","year":"2000","journal-title":"Clin Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1111\/j.1365-2036.2005.02645.x","article-title":"Systematic review: tuberculous peritonitis\u2013presenting features, diagnostic strategies and treatment","volume":"22","author":"Sanai","year":"2005","journal-title":"Aliment Pharmacol Ther"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S83","DOI":"10.1177\/089686080502504S12","article-title":"Recommendations on the management of encapsulating peritoneal sclerosis in Japan, 2005: diagnosis, predictive markers, treatment, and preventive measures","volume":"25","author":"Kawaguchi","year":"2005","journal-title":"Perit Dial Int"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.2215\/CJN.01820408","article-title":"Assessing the validity of an abdominal CT scoring system in the diagnosis of encapsulating peritoneal sclerosis","volume":"3","author":"Tarzi","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1046\/j.1523-1755.1999.00264.x","article-title":"The peritoneal membrane in chronic peritoneal dialysis","volume":"55","author":"Krediet","year":"1999","journal-title":"Kidney Int"},{"key":"ref7","first-page":"11","article-title":"Encapsulating peritoneal sclerosis-a 5 year experience","volume":"82","author":"Spence","year":"2013","journal-title":"Ulster Med J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1177\/089686080902900508","article-title":"Computed tomographic findings characteristic for encapsulating peritoneal sclerosis: a case-control study","volume":"29","author":"Vlijm","year":"2009","journal-title":"Perit Dial Int"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1056\/NEJMoa1803396","article-title":"Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis","volume":"380","author":"Wilson","year":"2019","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1777805\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:25:36Z","timestamp":1775107536000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1777805\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":9,"alternative-id":["10.3389\/fmed.2026.1777805"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1777805","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]},"article-number":"1777805"}}