POS-672 EFFLUENT PERITONEAL DIALYSIS FLUID TURBIDITY CAN REVEAL COLON CANCER

ABSTRACT

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