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Introduction: Infectious peritonitis (IP) is one of the main complications in peritoneal dialysis (PD). Abdominal pain is often the revealing symptom of this complication which can also be clinically silent and diagnosed after the discovery of a cloudy aspect of the effluent dialysis fluid. Other etiologies may mimic the symptoms of IP in PD. Methods: We report the case of a PD patient who presented with abdominal pain and turbid peritoneal fluid with a biological inflammatory syndrome, and the final diagnosis was peritoneal carcinomatosis complicating colon cancer. Results: A 71-year-old female patient with a history of hypertension and vascular end-stage kidney disease. She started two years earlier (2019) on peritoneal dialysis. During these two years, she had undergone only one episode of infectious peritonitis. She presented in January 2021 with deep asthenia. There were no abnormalities in the clinical examination. Laboratory tests were normal except for normocytic normochromic anemia (8g/dl). SARS-CoV-2 infection was suspected given the epidemiological context but we performed a test (Polymerase Chain Reaction) and it was negative. Three months later she presented with abdominal pain and asthenia. The clinical examination found the right-side abdomen sensitive to touch. Dialysis fluid was turbid and the cytobacteriological examination showed hypercellularity with 90% of neutrophils with a negative culture. She also had hyperleukocytosis (12770 e/mm3) with neutrophil predominance, microcytic anemia (6.2d/dl), a high c reactive protein (CRP) level (133.3 mg/l), and procalcitonin level was 1.49 ng/ml. She was put on an empiric antimicrobial therapy. Abdominal pain remained intense after 48 hours with an altered general condition, which motivated the request for computed tomography (CT) scan of the abdomen. The CT scan showed an irregular process tissue of the right colic angle with invasion of segment VI of the liver and peritoneal carcinomatosis. Conclusions: The indication of imaging exams should be broadened so as not to miss out on serious diagnoses that mimic IP No conflict of interest
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Déclaration de liens d’intérêts: Les auteurs déclarent ne pas avoir de liens d’intérêts.
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BACKGROUND AND AIMS: Cryoglobulinaemic vasculitis (CV) leading to clinically apparent skin lesions, and in some cases also to internal organ involvement such as renal involvement. The SARS Cov2 infection in this field is very serious and in the case of our patient the outcome was fatal. The aim of this work is to highlight the particularities of CV in this case CASE PRESENTATION: We report a case of a 62-year-old woman followed since 2014 for CV type 1 IgG Lambda revealed by vascular purpura and nasal septal perforation. the etiological assessment was negative. Hepatitis C virus serology was negative. A corticosteroid therapy at a dose of 1 mg/kg/day was started with partial improvement. Then the cyclophosphamide at a dose of 150 mg/d was added with a fairly good clinical result but stopped for hemorrhagic cystitis. Chlorominophene was started at a dose of 6 mg/d and then reduced to 4 mg/d for leuconeutropenia but the peripheral arterial manifestations (acrocyanosis of the limbs and ears) were not treated. The evolution was marked by the appearance of renal failure (creatinine 482.33 umol/l) associated with proteinuria at 1.32 g/24h. An outbreak of cryoglobulinemia was suspected. Plasma exchange was discussed as a therapeutic alternative and the patient was scheduled for a renal biopsy. However, the patient became febrile with the appearance of a dry cough and the presence of a biological inflammatory syndrome (CRP at 72). A SARS-CoV-2 PCR was completed which was positive. Therefore, she was put on antibiotic therapy (Azythromycin and Cefotaxime) associated with vitamin therapy and anticoagulant treatment. The patient was stable in terms of respiration and hemodynema, but her renal function worsened and progressed well under hydration. In addition, she presented with a slippage syndrome and she was died CONCLUSION: The natural history of CV is not predictable and strongly depends on concomitant diseases and complications and response to treatment. The SARS Cov2 infection can complicate its evolution. There is no association has been described between them to our knowledge.
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BACKGROUND AND AIMS: The novel coronavirus disease 2019 (COVID-19) has now spread to the entire world as a highly contagious pandemic. The disease has proved to be more serious in populations with underlying diseases like kidney diseases, diabetes, or cardiovascular diseases. People with end-stage renal disease are known for their weakened immune systems and vulnerability to different types of infections. Recent studies have shown high prevalence and poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in hemodialysis patients, but its effect on peritoneal dialysis (PD) patients is still unknown. The aim of this study was to investigate the clinical, biological, and scannographic particularities and the prognosis of SARS-CoV-2 infection in patients on PD. METHOD: We conducted a monocentric descriptive study including all the confirmed cases of SARS-CoV-2 infection in the PD unit of the Nephrology department in Charles Nicolle Hospital. The first confirmed case was in March 2019 and our study period ended in January 2021. We used Real-Time Reverse Transcriptase polymerase chain reaction (RT- PCR) to confirm SARS-CoV-2 infection after nasopharyngeal swabbing. RESULTS: Eight patients were included: 7 men and 1 woman. The mean age was 40.25 years-old [22-60]. All the patients were hypertensive, 2 of them were diabetics and 3 of them had cardiac pathologies: coronary heart disease in 2 patients and atrial fibrillation in the other patient. One patient had history deep vein thrombosis. All the patients were on automated PD with an average duration of PD of 40.56 months [1-84]. Two of them had history of peritonitis. Regarding the revealing symptoms of COVID-19, all the patients suffered from asthenia, a deterioration of general condition was observed in 7 patients, dry cough was also present in 7 patients, 4 patients described muscle and body aches, 3 patients reported diarrhea and vomiting, dyspnea was observed in 2 patients, only one patient reported loss of taste and smell, and fever was present in only one case.Two patients had low peripheral oxygen saturation (70% and 88%). All the patients had lymphopenia with an average of 557 [900-280]. C-reactive protein was high in 6 patients with an average of 84.7 mg/l. Chest computed tomography (CT) scan was practiced in 3 patients, it was positive in all of them with average extent of damage of 60%. Four patients were admitted in hospital and one of them in the intensive care unit (ICU) for high oxygen needs. All the patients received azithromycin, and vitamin C and D and zinc supplementation. A preventive dose of heparin was prescribed in 5 patients. No patient required intubation. No patient had thromboembolic complications. Six patients fully recovered since more than one month. Regarding the other two patients we have a follow-up of only one week since the beginning of symptoms, one of them is pauci-symptomatic and the other one is still admitted in the ICU. CONCLUSION: According to our findings, patients on PD are not at increased risk for severe illness from COVID-19 or other adverse outcomes.
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BACKGROUND AND AIMS: Since its outbreak in December 2019,novel coronavirus disease 2019 (COVID-19) has become one of physicians top concerns worldwide. Special attention is payed to immunocompromised patients with whom the virus is feared to be more aggressive . Our aim was to assess outcomes in patients receiving immunosuppressive therapy who presented with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2) infection. METHOD: we monitored patients undergoing immunosuppressive regimens who presented with SARS- CoV-2 infection during a four months period from September to December 2020 in the Nephrology department of Charles Nicolle's Teaching Hospital. The diagnosis was made through nasopharyngygeal swabs. Kidney transplant patients were not included. RESULTS: we identified 9 patients who presented a confirmed SARS-CoV-2 infection (details are shown in figure 1). Age varied from 32 to 67 years. Gender ratio was 0,8. Six patients had hypertension and one patient had diabetes. Seven patients suffered from chronic kidney disease stage 4 (2 patients) and stage 5 (5 patients). Active smoking was noted in 4 patients. Indications for immunosuppressive therapy were vasculitis (5patients) , lupus nephritis (1 patient) , scleroderma (1patient), cryoglubulinemia (1 patient) and multiple myeloma (1 patient). Therapies used included corticosteroids alone (2 patients) or in association with cyclophosphamide (6 patients) and in one case bortezomib. COVID-19 symptoms included fever (6 patients), fatigue (7 patients), joint pain (3 patients), dry cough (all patients)and diarrhea ( one patient). Medium duration under immunosuppressive treatment was of 42,1 days when COVID-19 diagnosis was made Among the patients, six had a mild COVID-19 presentation and displayed favorable outcomes;whereas the remaining three had severe symptoms requiring high dose oxygen and died. As for the renal outcomes, we observed no detioration of kidney function following the COVID-19 infection in any of the patients .All of the patients were treated with antibiotics, heparin and vitamins. CONCLUSION: SARS- CoV-2 infection is a serious condition that can threaten prognosis especially in patients receiving immunosuppressive drugs responsible for a weaker immune response. Further work on a larger group of patients is necessary to establish whether this group is more prone to contract the COVID-19 infection and have poorer outcomes.