Cloudy Dialysate as the Initial Presentation for Lymphoma

Sriperumbuduri, Sriram; Zimmerman, Deborah

doi:10.1155/2018/2192043

Cited by 3 publications

(9 citation statements)

References 11 publications

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“…Lymphatic obstruction secondary to lymphoma is another cause of chylous effluent. 56 Acute pancreatitis, 57 certain calcium channel blockers, 58 superior vena cava syndrome, 59 and trauma to the lymphatics following PD catheter insertion are additional causes. 60 …”

Section: Not All Abdominal Pain or Cloudy Effluent Is Peritonitismentioning

confidence: 99%

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

2020

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Peritonitis is a common complication of peritoneal dialysis that is associated with substantial morbidity and mortality. Peritonitis increases treatment costs and hospitalization events and is the most common reason for transfer to hemodialysis. Although there is much focus on preventing peritoneal dialysis–associated peritonitis, equally as important is appropriate management to minimize the morbidity of a peritonitis episode when it has occurred. Despite the presence of international guidelines on peritonitis treatment, the evidence base to support optimal peritonitis treatment practices is lacking, leaving the practitioner to rely on clinical experience and extrapolate from across other infection treatment practices. This article reviews common mistakes and misconceptions that we have observed in the management of peritonitis that may compromise treatment success. It also provides suggestions on common controversial aspects of peritonitis management based on the best available literature. Although the use of the word mistakes is somewhat controversial and subjective, we acknowledge that evidence is lacking and have based many of our suggestions on clinical judgment, experience, and available data.

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Section: Not All Abdominal Pain or Cloudy Effluent Is Peritonitismentioning

confidence: 99%

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

2020

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“…In these cases, cytological analysis is key, occasionally establishing previously unrecognized diagnosis of lymphoma and other metastatic neoplasms 6 . Flow cytometry (FC) of the dialysate can also be useful – Sriperumbuduri et al, for example, described its use in a patient with a turbid effluent where FC facilitated the diagnosis of lymphoma after a negative cytology for malignant cells 5 . In our patient, flow cytometric immunophenotyping of the PF was suggestive of a benign reactive process.…”

Section: Discussionmentioning

confidence: 75%

“…Nonetheless, infection does not explain all cases of cloudy effluent and other potential causes must be considered (e.g. neoplasms and iatrogenic aetiologies) 5–10 . We present an atypical case of peritonitis, reviewing some of the differential diagnosis considered throughout the workup and, finally, the diagnostic and therapeutic options available for the established cause.…”

Section: Introductionmentioning

confidence: 96%

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Clearing the clouds: Case‐report and review of the literature

Relvas

Beco

Pereira

et al. 2020

Seminars in Dialysis

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In peritoneal dialysis (PD), a cloudy dialysate is an alarming finding. Bacterial peritonitis is the most common cause, however, atypical infections and non‐infectious causes must be considered. A 46‐year‐old man presented with asthenia, paraesthesia, foamy urine and hypertension. Laboratory testing revealed severe azotaemia, anaemia, hyperkalaemia and nephrotic‐range proteinuria. Haemodialysis was started through a central venous catheter. Later, due to patient preference, a Tenckhoff catheter was inserted. Conversion to PD occurred 3 weeks later, during hospitalization for a presumed central line infection. A month later, the patient was hospitalized for neutropenic fever. He was diagnosed an acute parvovirus infection and was discharged under isoniazid for latent tuberculosis. Four months later, the patient presented with fever and a cloudy effluent. Peritoneal fluid (PF) cytology was suggestive of infectious peritonitis, but the symptoms persisted despite antibiotic therapy. Bacterial and mycological cultures were negative. No neoplastic cells were detected. Mycobacterium tuberculosis eventually grew in PF cultures, despite previous negative molecular tests. Directed therapy was then initiated with excellent response. Thus, facing a cloudy effluent, one must consider multiple aetiologies. Diagnosis of peritoneal tuberculosis is hampered by the lack of highly sensitive and specific exams. Here, diagnosis was only possible due to positive mycobacterial cultures.

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“…9,11 The malignancy diagnosis was made by the cytological analysis of the peritoneal effluent in only two of these reports. 7,12 The peritoneal effluent was described as cloudy in six cases. There was variability concerning cellularity, with a tendency of mononuclear cell predominance.…”

Section: Discussionmentioning

confidence: 99%

Cloudy fluid, cloudy diagnosis

et al. 2022

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Here, we report a case of a patient with cloudy effluent that was initially diagnosed as bacterial peritonitis. The persistence of a cloudy effluent despite antibiotic therapy led to an extensive peritoneal dialysis (PD) effluent analysis, with the final diagnosis being high-grade B-cell lymphoma. This case will increase the awareness of this rare presentation of a lymphoproliferative disorder reminding clinicians to consider this diagnosis as a part of the differential diagnosis PD effluent.

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Cloudy Dialysate as the Initial Presentation for Lymphoma

Cited by 3 publications

References 11 publications

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

Clearing the clouds: Case‐report and review of the literature

Cloudy fluid, cloudy diagnosis

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