Presented with central nervous system involvement, extra- pulmonary and intra-pulmonary tuberculosis combined infection in a dialysis patient

The clinical  appearance of Mycobacterium tuberculosis (TB) in patients on dialysis aresubstantially  non-specific that makesdiagnosis difficult. We report a case of extrapulmonary and intrapulmonary TBin end stage renal disease (ESRD). A 58- year-oldfemale with ESRD was addmitted to emergency with the complaints of  intermittent fever, weakness, impairment ofconsciousness for last three days. Because of mental confusion she wasentubated, transferred to the intensive care unit. ThoraxCT showed widespread sentriasiner nodules in both lungs. The empirically anti-TBtherapy was initiated. There was in size of 4x5 cm palpablelymphadenopaty on left supraclavicular region, excisional biopsy revealed caseatinggranulomatous lymphadenitis. Lomber ponction was performed, analysis revealedconsistent with TB meningitis. The patient was diagnosed as miliary TB, TB meningitisand TB lymphadenitis and died on the tenth day on admission. Increased awarenessof TB in the ESRD population, early diagnosis and treatment are very important.