Abstract: SA-PO709

Non-Infectious Peritoneal Dialysis Exit Site Rash: Unusual Case Report and Review of Literature

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Ravula, Srilakshmi, University of Arkansas Medical Center, Little Rock, Arkansas, United States
  • Siddiqui, Mohammed M., None, Little Rock, Arkansas, United States
  • Rabadi, Omar, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Singh, Manisha, University of Arkansas For Medical Sciences, Little Rock, Arkansas, United States
Background

Peritonitis is one of the leading causes of morbidity in patients on peritoneal dialysis(PD). Exit site infections(ESI) can cause six-fold increase in the risk of peritonitis. Exit site infection is characterized by purulent drainage,erythema,pain and swelling at PD catheter site.On review of literature case reports of non-infectious exit site rash are found to be rare,hence we are reporting this case of PD exit site non-infectious rash that was finally diagnosed as granuloma gluteal adultorum.

Methods

A 74-year-old white man with ESRD from diabetes on CCPD(continuous cycler assisted PD) presented with localized area of redness, itching and serous drainage around PD catheter site measuring 1x1cm. The lesion was noticed week ago that progressively worsened.He denied trauma to catheter site,pain,fever or cloudy effluent.He was compliant with exit site care instructions and was using mupirocin ointment as part of catheter care regimen,denied changes in medications or povidone iodine use.On exam,abdomen was soft and no purulent drainage was expressed from exit site.PD fluid cell count ruled out peritonitis.Exit site cultures were obtained & keflex was started.

On follow up exam,it was noted that areas of skin desquamation had gotten worse with increased itching.Dermatology was consulted and shave skin biopsy was done.Histopathological findings were consistent with spongiotic dermatitis with eosinophils,diagnosis of granuloma gluteale adultorum was made.Topical zinc oxide was prescribed in addition to continuing topical antibiotic therapy. Patient had significant improvement in one week.

As discussed,erythema with pain and purulent discharge are hallmarks of ESI.There have been very few case reports published reviewing non-infectious PD site dermatitis.

Conclusion

ESI is a differential for catheter site erythema,pain and discharge.Empiric treatment with antibiotics is warranted.Prompt dermatological assessment and skin biopsy should be considered if there is no resolution of symptoms.

Review of Case Reports
Authors et alAgent IdentifiedDescription of RashManagement
Elvira O. GosmanovaGentamicin-induced contact dermatitisOvoid crusted plaque with peripheral rim of erythemaStopped gentamicin cream and switch to Mupirocin
Yavascan OPovidone IodinePatchy,linear erythemaDaily Application of Normal Saline
Chasset FPovidone IodineBullous EruptionSwitch betadine to chlorhexidine
Roland SchmittOcteniseptExpanding erythematous rashAvoid allergen
Satoshi KuriharaSilicone RubberEczematous skin rashAntihistaminic ointment