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Kidney Week

Abstract: PO1282

A Unique Case of Encapsulated Peritoneal Sclerosis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Kacharam, Sumanth, Brown University, Providence, Rhode Island, United States
  • Tang, Jie, Brown University, Providence, Rhode Island, United States
Introduction

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating sequela of chronic inflammation in patients on peritoneal dialysis (PD). EPS is classically associated with filtration failure and can lead to recurrent abdominal pain and obstruction due to encasement of small and large bowel

Case Description

A 45 year-old Cambodian male with a past medical history of ESRD secondary to IgA nephropathy on PD for 10 years presented with loose stools and hypotension after dialysis. His medical history included CML complicated by spinal chloroma, paraplegia, neurogenic bladder and PVD with osteomyelitis resulting in bilateral AKA. He was previously admitted 14 days prior for culture negative (including fungal) peritonitis treated with intraperitoneal cefepime and C. difficile colitis treated with oral Vancomycin. Despite completing a course of antibiotics, he had persistent abdominal pain and inability to tolerate PO intake. Repeat diagnostic paracentesis on this presentation revealed a total cell count of 2519 with 98% PMN. But culture remained negative. CT of abdomen showed global thickening and calcification of his peritoneal membranes. Ex laparotomy was performed with biopsies confirming EPS. At the time of diagnosis, he did not exhibit signs or symptoms of dialysis failure with excellent ultrafiltration. Repeat microbiology studies showed fungal elements in the PD fluid, later identified as penicillium species mold. Patient was not started on Steroids and Tamoxifen due to underlying fungal peritonitis.He was transitioned to hemodialysis and treated with a prolonged course of amphotericin. Subsequent peritoneal studies showed increasing burden of mold despite intraperitoneal drains. His course was further complicated by recurrent upper GI bleed and inability to tolerate hemodialysis due to hypotension. Patient was eventually transitioned to comfort measures.

Discussion

The pathogenesis stilof EPS is poorly understood. Some of the risk factors include use of PD for > 5 yrs, high dialysate glucose concentrations, repeated episodes of peritonitis, which can cause structural and functional damage to the peritoneal membrane.Development of EPS is related to dialysis vintage and "second hits" like infection as demonstrated in this case. However, the case is unique in that he had no difficulty with his PD ultrafiltration, and we believe the fungal peritonitis was a late sequala of his EPS.