A Case Report of Rash at Peritoneal Dialysis Exit Site

Abstract

The International Society for Peritoneal Dialysis recommends the regular application of topical antibiotic-containing preparations in addition to a routine exit site care to reduce the risk of exit site infection (ESI). Among these prophylactic antimicrobial preparations, topical gentamicin is one of the widely used and effective antibiotics for prevention of ESI and peritonitis in peritoneal dialysis (PD) patients. Overall, topical gentamicin is well tolerated; however, its use can be associated with the development of allergic contact dermatitis (ACD). We describe a first reported case of PD catheter exit site contact ACD due to topical gentamicin mimicking ESI. The patient in this report developed worsening violaceous in color and pruritic rash surrounding the PD catheter exit site that appeared 3 weeks after the initiation of gentamicin cream. The association between development of rash and initiation of topical gentamicin led to a suspicion of local reaction to gentamicin rather than ESI. Skin biopsy confirmed ACD. Discontinuation of the provoking agent and subsequent treatment with topical hydrocortisone application led to a resolution of the exit site rash. Any rash at a PD catheter exit site should be considered infectious until proven otherwise. However, it is important to be aware of noninfectious etiologies of exit site rashes as the treatment of these 2 conditions differs.

Noninfectious Peritoneal Dialysis Exit Site Rash—An Unusual Case Report and Review of the Literature

“… Agent identified Rash description Measures taken 1 Gosmanova et al . 2015 3 Gentamicin-induced contact dermatitis Ovoid crusted plaque, violaceous in color with a peripheral rim of erythema and without granulation Stopping gentamicin cream and initiating hydrocortisone 2.5% cream. Switched to Mupirocin 2 Yavascan et al .…”

A Hyperpigmented Reticular Rash in a Patient on Peritoneal Dialysis

“…Additionally, they can develop unusual or under-recognized conditions that may be overlooked due to their other medical problems. This is especially true in pediatric patients and patients on dialysis (1)(2)(3)(4)(5). Because of these tendencies, medical providers caring for complex patients need to be diligent in recognizing potentially significant findings; in particular, rashes are often important indicators of an unrecognized medical condition (6,7).…”