Eosinophilic Peritonitis Followed by Acute Colonic Pseudo-obstruction (Ogilvie's syndrome) in an ESRD Patient on CAPD / 대한신장학회잡지

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by massive dilatation of the colon with no sign of mechanical obstruction. We report a case of eosinophilic peritonitis with severe abdominal pain followed by acute colonic pseudo- obstruction in an ESRD patient on CAPD. The intravenous administration of neostigmine, an acetylcholinesterase inhibitor, resulted in safe and effective colonic decompression in our patient. In case patients with acute colonic pseudo-obstruction do not respond to conservative therapy, treatment with neostigmine can be considered even for patients on dialysis.

Eosinophilic Peritonitis in a Patient with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24, 500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216, 000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. Creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.

Symptomatic Eosinophilic Peritonitis in CAPD Treated with Low Dose of Oral Prednisolone / 대한신장학회잡지

Eosinophilic peritonitis is not uncommonly observed in patients on peritoneal dialysis. It typically occurs within the first 3 months after the initiation of peritoneal dialysis. Eosinophilic peritonitis is usually a benign and self-limiting process with the exception of fungal eosinophilic peritonitis. The use of oral or intraperitoneal steroids has been suggested only for patients with abdominal pain or with markedly turbid peritoneal effluent. We report a case of eosinophilic peritonitis with severe abdominal pain, which successfully resolved on treatment with single dose of oral prednisolone.