Peritoneal dialysis related eosinophilic peritonitis: a case report and review of the literature

Abstract

Background Overt eosinophilic peritonitis (EP) is a relatively uncommon complication of peritoneal dialysis (PD), although not rare. Here we reported a case of EP relieved after changing dialysate. Case presentation A 28-year old male patient developed cloudy PD effluents within the first month after PD started. Cytological study of PD effluents showed elevated white blood cells and polynuclear cells. Bacteria culture of PD effluents repeated for several times were all negative, and no pathogen was found by metagenomics next generation sequencing (mNGS). Antibiotic therapy for 28-day was ineffective. Based on these and increased eosinophils in peritoneal fluid, he was finally diagnosed as EP. PD dialysate was changed (consists of the same buffer agent and electrolytes, but is packed in bags that do not contain PVC), and the patient’s PD effluent became clear. Of note, EP did not relapse 5 months later when the patient started to use the former PD solution again. Conclusion Although PD effluent turbidity almost always represents infectious peritonitis, there are other differential diagnoses including EP. For patients with cloudy fluid accompanied by mild symptoms who do not response to antibiotic therapy, it is reasonable to consider the possibility of this disease. EP tends to heal spontaneously, however, antihistamines or glucocorticoids are required sometimes to avoid catheter obstruction. For patients with no obvious incentives, replacement of dialysate may be useful.

Peritoneal dialysis-associated peritonitis, caused by superior mesenteric artery thrombosis with intestinal necrosis: a case report

“…Moreover, his abdominal pain had not been ameliorated. In cases of inadequate response to antimicrobial treatment, eosinophilic peritonitis should be considered [30]. In this case, we ruled out the eosinophilic peritonitis because there was no increase of eosinophils in PD effluent throughout the clinical course.…”

Sterile inflammation of peritoneal membrane caused by peritoneal dialysis: focus on the communication between immune cells and peritoneal stroma

“…Despite the documented biocompatibility of currently used catheters, there is extensive evidence of increased eosinophil counts in both peripheral blood and peritoneal fluid following catheter replacement. This response can range from a mild increase in asymptomatic individuals to a severe elevation that can ultimately lead to eosinophilic peritonitis ( 186 – 191 ). Eosinophilic peritonitis is characterized by aseptic inflammation, manifested as cloudy peritoneal dialysis effluent, mild clinical symptoms, negative dialysate culture, and lack of response to antibiotic treatment ( 191 ).…”

“…This response can range from a mild increase in asymptomatic individuals to a severe elevation that can ultimately lead to eosinophilic peritonitis ( 186 – 191 ). Eosinophilic peritonitis is characterized by aseptic inflammation, manifested as cloudy peritoneal dialysis effluent, mild clinical symptoms, negative dialysate culture, and lack of response to antibiotic treatment ( 191 ). Tissue invasion, resulting from infection and/or nonspecific stimulation of the PDFs, triggers the release of danger signals that activate eosinophils.…”

Complications of Peritoneal Dialysis Part II

“…Early presentations that occur within weeks after PD initiation are believed to be related to an allergic response to either air introduced at the time of catheter insertion or chemicals found in the dialysate, dialysate bag, or tubing. 28–30 A prospective study in 2007 showed that 6.3% of patients starting continuous ambulatory PD demonstrated eosinophilic dialysate within the first 30 days of dialysis initiation. 26 All cases spontaneously resolved within the same study period without any treatment.…”