Diagnosis of Lymphoma in a Continuous Ambulatory Peritoneal Dialysis Patient by Peritoneal Fluid Cytology

Cloudy Peritoneal Dialysate: It’s not Always Infection

“…These findings were consistent with large non-cleaved lymphoma cells [11]. In a similar case reported by Bargman et al [12] cytological analysis of sterile cloudy dialysate established the diagnosis of a previously unrecognized lymphoma. Neoplasms metastatic to the peritoneum may also cause cloudy dialysate.…”

“…The opalescence associated with the increased triglyceride levels waxes and wanes depending on the fat content of ingested meals [14]. The most common cause of chylous peritoneal dialysate is lymphatic obstruction secondary to malignancy, in particular lymphoma [12]. Acute pancreatitis may also cause chylous dialysate; the swollen pancreas might impede lymphatic drainage by directly compressing the lymphatic channels as they converge on the cisterna chili [15].…”

Noninfectious Causes of Cloudy Peritoneal Dialysate

“…The opalescence associated with the increased triglyceride levels waxes and wanes depending on the fat content of ingested meals (32). The most common cause of chylous peritoneal dialysate is lymphatic obstruction secondary to malignancy, in particular lymphoma (30). Acute pancreatitis may also cause chylous dialysate (33).…”

Cloudy Dialysate as the Initial Presentation for Lymphoma

“…Earlier reports suggested a poor prognosis with this complication in patients with lymphoma [ 7 ], but more recent studies show improved outcomes with the advent of newer chemotherapy regimens [ 8 ]. Very few case reports exist about lymphoma leading to chylous ascites in PD patients [ 9 , 10 ]. Daily lavage of peritoneum actually facilitates diagnosis of this condition at a potentially earlier stage in these patients, as in our case where the high triglyceride level was detected at the first appearance of cloudy effluent.…”