Abstract: TH-PO1210
Eosinophilic Peritonitis in a Pediatric Patient: A Case Report
Session Information
- Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Borsheim, Brianna, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
- Dalal, Vidhi, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
Introduction
Eosinophilic peritonitis (EP) can be difficult to distinguish from bacterial peritonitis and is frequently misdiagnosed. It is estimated that EP accounts for one third of culture-negative peritonitis episodes in children.
Case Description
A 16-month-old female with a past medical history of chronic kidney disease (CKD) stage 5 due to reflux nephropathy and renal dysplasia presented to the emergency room with cloudy peritoneal dialysis (PD) effluent fluid and concern for infection. The patient had a PD catheter placed 2 weeks earlier and had not yet started on PD. The patient had no fever, abdominal pain, irritability, or vomiting. Her vitals and physical exam were unremarkable; her PD fluid was cloudy and cell count revealed 2044 white blood cells (WBCs) with 35% neutrophils and 19% eosinophils. Her urinalysis was consistent with a urinary tract infection (UTI). The patient was discharged home from the emergency room on oral antibiotics for the UTI and nystatin prophylaxis. She did well without development of infectious symptoms and her PD culture resulted negative after 120 hours. Upon initiation of PD, the patient experienced catheter dysfunction and laparoscopy revealed catheter adhesion to bowel. After multiple attempts, the patient was unable to initiate PD. Her catheter was removed and she was started on hemodialysis.
Discussion
The differential for cloudy effluent fluid is broad and includes both infectious and eosinophilic peritonitis. To our knowledge, there are no well-defined guidelines for the diagnosis and treatment of EP. Our patient’s clinical presentation was more consistent with EP given the elevated total WBC count with high eosinophil percentage (>10%) in the PD fluid, absence of infectious symptoms, and recent catheter placement. The causes of EP include hypersensitivity of the peritoneal membrane, mechanical irritation due to the catheter, and surgical interventions. Further, though the reason is unknown, there seems to be a higher likelihood of EP in younger children. EP is often benign and resolves without intervention, as in our patient. However, intaperitoneal hydrocortisone and oral antihistamines have been trialed with variable effects. This case provides insight into EP and how timely diagnosis can prevent antibiotic overuse, shorten hospital length of stay and improve outcomes. Further studies are needed to assess if EP prior to PD initiation or if treatment of EP impacts the success of PD.