Pathological changes in chronic eosinophilic peritonitis in peritoneal dialysis patient

Abstract

We report the pathological findings of the peritoneum in a patient with chronic eosinophilic peritonitis. Peripheral blood eosinophilia was confirmed before insertion of Tenckhoff catheter. Eosinophilic peritonitis continued from the second day after initiation of peritoneal dialysis for 18 months. Pathological findings showed numerous eosinophils in peritoneal blood vessels. Mast cells were also detected in the peritoneum, while neoangiogenesis was not prominent. The highly permeable state of the peritoneal membrane may be due to inflammatory mediators, such as tryptase. Mast cells may be involved in high peritoneal permeability in such patients.

Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

“…This reaction might be induced and sustained by cytokines, including interleukin 5, released at the inflammation site, complement activation, and the complements C3a and C5a [9, 33]. The increase and activation of eosinophils in the blood and PD fluid have been reported not to cause any adverse effects on peritoneal function or other outcomes in patients on PD [2, 10, 11], whereas several studies have demonstrated contradictory findings, including detrimental effects, particularly on the peritoneal membrane, leading to EPS in the worst-case scenario [12, 13, 34]. Although we did not investigate ECs in the PD fluid in this study, the increase in peripheral blood EC persisted for 1 year after PD catheter insertion, which might have been partially exacerbated by the use of the PD fluid including icodextrin and PD systems with bags and tubes in the follow-up period; it remains plausible that the long-term increase and activation of eosinophils in the blood and PD fluid might have had adverse effects in patients on PD.…”

“…We hypothesized that even a small increase in EC at the time of PD catheter insertion might affect long-term outcomes in patients on PD, presumably through interaction with peritoneal membrane function. Several case reports demonstrated pathological changes in the peritoneal membrane after chronic peritoneal fluid eosinophilia, causing encapsulating peritoneal sclerosis (EPS) in 1 case [12, 13]. We evaluated the association of eosinophilic reaction with PD catheter insertion with technique survival as well as peritonitis and heart failure (HF).…”

Cytomorphological changes induced by intraperitoneal chemotherapy present important diagnostic pitfalls in peritoneal fluid cytology

“…While eosinophils in pleural effusions have been described in several clinical settings, they are less commonly found in peritoneal fluids. Eosinophils in peritoneal fluid specimens have been mainly described in patients undergoing peritoneal dialysis with or without concurrent intra‐abdominal infections …”

Eosinophilic peritonitis in children undergoing maintenance peritoneal dialysis: A case report and literature review

“…Infiltration of high number of eosinophils in the peritoneal blood vessels in the peritoneal biopsy suggested that non-PD-related allergic reactions can be associated with EP development. 34 Peripheral blood eosinophilia may sometimes become symptomatic. 35 However, there is usually no history for systemic hypereosinophilic syndrome in EP patients.…”