Hemophagocytic Lymphohistiocytosis as a Complication of Peritoneal Dialysis–Associated Peritonitis and Miliary Tuberculosis

We report a unique case of peritoneal dialysis (PD)–associated peritonitis secondary to disseminated tuberculosis that was complicated by hemophagocytic lymphohistiocytosis. A 60-year-old woman who had recently begun PD presented with jaundice and anasarca 1 month after being treated for bacterial peritonitis. Findings of an investigation revealed disseminated tuberculosis: peritonitis and miliary pulmonary nodules, as well as hemophagocytosis on liver biopsy. Treatment included multidrug antituberculosis regimen, intravenous immunoglobulin, and dexamethasone. This patient developed hemophagocytic lymphohistiocytosis secondary to disseminated tuberculosis, complicating PD-associated peritonitis. This is the first reported case, to our knowledge, in the United States and highlights the importance of early detection and treatment in improving survival.