ABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a clinical radiologic syndrome which is characterized by reversible neurological and radiological findings. It is associated with an abrupt and severe increase in blood pressure, eclampsia, chronic kidney disease with hypertension and using various immunosupressive drugs. Patient with chronic kidney disease could be especially vulnerable to this syndrome because they are frequently exposed to several possible causes as uremia, hypertension, or electrolyte imbalance. We report a case of posterior reversible encephalopathy syndrome in a patient having continuous ambulatory peritoneal dialysis.
Subject(s)
Female , Humans , Pregnancy , Blood Pressure , Eclampsia , Hypertension , Kidney Failure, Chronic , Peritoneal Dialysis, Continuous Ambulatory , Posterior Leukoencephalopathy Syndrome , Renal Insufficiency, Chronic , UremiaABSTRACT
A 53-year-old male was hospitalized with abdominal pain and turbid peritoneal fluid. He was diagnosed with hypertension, diabetic nephropathy and started continuous ambulatory peritoneal dialysis (CAPD) 4 years ago. Initial peritoneal fluid analysis demonstrated CAPD peritonitis. As initial antibiotic therapy, ceftazidime/vancomycin were injected intraperitoneally. But drug sensitivity test revealed these regimens were ineffective. On sixth hospital day, Brevundimonas vesicularis (B. vesicularis) was cultured from peritoneal fluid, this strain was susceptible to imipenem, piperacillin and resistant to ceftazidime. Accordingly we changed the antibiotics to imipenem, which was administered for 14 days, but analysis of peritoneal fluid was seldom improved. Finally, CAPD catheter was removed, and hemodialysis was started. After CAPD catheter removal, peritonitis improved rapidly. B.vesicularis is a rare opportunistic organism in CAPD peritonitis. Because this peritonitis may not improve in spite of medical treatment with susceptible antibiotics, CAPD catheter must be removed finally.