A Case of Eosinophilic Peritonitis Treated with Oral Corticosteroids

Abstract

Malnutrition is widely prevalent in dialysis (1,2). Malnourished patients show a decrease in lean body mass (LBM) that reflects a depletion of somatic protein stores. LBM measurements are not routinely performed in dialysis patients due to the lack of simple and precise techniques for its determination. Recently, we compared lean mass measurements performed by densitometry and by creatinine kinetics in a group of stable peritoneal dialysis patients (5 females, 1 male; mean age 59 ± 11 years; mean time on peritoneal dialysis 22.5 ± 10.1 months). We also correlated lean mass measurements with laboratory determinations that estimate nutritional status. Densitometry was performed with a Norland XR 26 densitometer (Norland XR26, Madison, WI, U.S.A.) using dynamic filtration (3). To determine LBM by creatinine kinetics, we measured the creatinine production of each patient, estimated from excretion and metabolic degradation (4). Then, on the basis of the relationship that exists between creatinine production and LBM (5), we calculated the LBM that corresponded to the creatinine production of each patient.We found that lean mass determined by densitometry was 37.86 ± 2.17 kg in the females and 46.8 kg in the male. Lean mass by this method represents 49.52% of body weight in the females and 72.04% in the male. Lean mass determined by creatinine kinetics was 38.44 ± 1.46 kg in the females and 44.15 kg in the male, representing 50.50% of body weight in the females and the 68.5% in the male.We found no significant difference and a very good correlation in mean lean mass values between techniques (r = 0.95; p = 0.004) (Figure 1). Lean mass determined by both methods correlated significantly with the height but not with the weight of the patients. No correlations were found between lean mass determinations by both methods and laboratory determinations that estimate nutritional status, such as serum albumin, transferrin, whole lymphocyte count, and serum creatinine. Other studies (6), however, have found that, although the correlation be-

Successful Treatment of Idiopathic Eosinophilic Peritonitis by Oral Corticosteroid Therapy in a Continuous Ambulatory Peritoneal Dialysis Patient

“…A short course of low-dose oral prednisone acetate has been suggested for patients to maintain catheter patency if the peritoneal fluid is markedly turbid. Because of potential side effects of long-term prednisone acetate therapy, it would not be appropriate for the majority of asymptomatic self-limited cases [ 9 ]. This case reminds us that the diagnosis of EP should be considered when repeated cultures are always negative and the turbidness of peritoneal dialysis effluent persists in spite of an antibiotic therapy.…”

Pathological changes in chronic eosinophilic peritonitis in peritoneal dialysis patient

“…Thus, inflammatory mediators may be involved in developing high peritoneal solute transport by increasing vascular permeability; for example, tryptase may accelerate vascular permeability as a result of direct or indirect generation of bradykinin [ 8 ]. Corticosteroid therapy is not usually recommended [ 1 ], but has recently been reported to be effective for severe cases of eosinophilic peritonitis, and may be useful for blocking these mechanisms, thereby controlling peritoneal permeability [ 9,10 ].…”

Eosinophilic Peritonitis Following Air Entrapment During Peritoneoscopic Insertion of Peritoneal Dialysis Catheters

“…Steroid therapy has been used to treat eosinophilic peritonitis (7,8). Asghar et al (7) reported a case of eosinophilic peritonitis associated with skin rash 2 weeks after starting PD. The investigators treated the patient with oral steroids gradually tapered over 10 weeks.…”