J Korean Med Sci.  2013 Apr;28(4):620-623. 10.3346/jkms.2013.28.4.620.

A Case of Fulminant Sclerosing Peritonitis Presented Like Acute Culture-Negative Peritonitis and Successfully Treated with Corticosteroid Therapy

• Jung JY
• Cho JT

• KMID: 1786973
• DOI: http://doi.org/10.3346/jkms.2013.28.4.620

Abstract

Sclerosing peritonitis is an uncommon complication of peritoneal dialysis. It is characterized by peritoneal fibrosis and sclerosis. The most common clinical presentations of sclerosing peritonitis in peritoneal dialysis patients are ultrafiltration failure and small bowel obstruction. The prognosis and response to immunosuppressive therapy of sclerosing peritonitis presenting with ultrafiltration failure or small bowel obstruction are poor. Here, we describe the case of a 28-yr-old man with end-stage renal disease on peritoneal dialysis showing fulminant sclerosing peritonitis presented like acute culture-negative peritonitis and was successfully treated with corticosteroid therapy. It is not well recognized that sclerosing peritonitis may present in this way. The correct diagnosis and corticosteroid therapy may be life-saving in a fulminant form of sclerosing peritonitis.

Keyword

Peritonitis; Peritoneal Sclerosis; Peritoneal Dialysis; Steroids

MeSH Terms

Acute Disease
Adult
Anti-Inflammatory Agents/therapeutic use
Humans
Kidney Failure, Chronic/therapy
Male
Peritoneal Dialysis/adverse effects
Peritonitis/*diagnosis/drug therapy/etiology
Prednisolone/therapeutic use
Sclerosis
Staphylococcus epidermidis/isolation & purification
Tomography, X-Ray Computed
Anti-Inflammatory Agents
Prednisolone

Figure

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  Fig. 1 CT scan of the abdomen. (A) On April 26, 2012, it showed diffuse thickening of parietal peritoneum, mesenteric thickening with vascular engorgement, and moderate amount of ascites. (B) On June 20, 2012, it showed decreased amount of ascites without significant change of peritoneal and mesenteric thickening.

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  Fig. 2 Clinical course of the present case of fulminant sclerosing peritonitis successfully treated with corticosteroid therapy.

Reference

1. Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. Perit Dial Int. 2000. 20:S43–S55.

2. Merkle M, Wörnle M. Sclerosing peritonitis: a rare but fatal complication of peritoneal inflammation. Mediators Inflamm. 2012. 2012:709673.

3. Mori Y, Matsuo S, Sutoh H, Toriyama T, Kawahara H, Hotta N. A case of a dialysis patient with sclerosing peritonitis successfully treated with corticosteroid therapy alone. Am J Kidney Dis. 1997. 30:275–278.

4. Kawanishi H, Harada Y, Noriyuki T, Kawai T, Takahashi S, Moriishi M, Tsuchiya S. Treatment options for encapsulating peritoneal sclerosis based on progressive stage. Adv Perit Dial. 2001. 17:200–204.

5. Rajani R, Smyth J, Koffman CG, Abbs I, Goldsmith DJ. Differential effect of sirolimus vs prednisolone in the treatment of sclerosing encapsulating peritonitis. Nephrol Dial Transplant. 2002. 17:2278–2280.

6. Evrenkaya TR, Atasoyu EM, Unver S, Basekim C, Baloglu H, Tulbek MY. Corticosteroid and tamoxifen therapy in sclerosing encapsulating peritonitis in a patient on continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. 2004. 19:2423–2424.

7. Courtney AE, Doherty CC. Fulminant sclerosing peritonitis immediately following acute bacterial peritonitis. Nephrol Dial Transplant. 2006. 21:532–534.

8. Rigby RJ, Hawley CM. Sclerosing peritonitis: the experience in Australia. Nephrol Dial Transplant. 1998. 13:154–159.

9. Martins LS, Rodrigues AS, Cabrita AN, Guimaraes S. Sclerosing encapsulating peritonitis: a case successfully treated with immunosuppression. Perit Dial Int. 1999. 19:478–481.

10. Kawanishi H, Kawaguchi Y, Fukui H, Hara S, Imada A, Kubo H, Kin M, Nakamoto M, Ohira S, Shoji T. Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study. Am J Kidney Dis. 2004. 44:729–737.

11. Kim BS, Choi HY, Ryu DR, Yoo TH, Park HC, Kang SW, Choi KH, Ha SK, Han DS, Lee HY. Clinical characteristics of dialysis related sclerosing encapsulating peritonitis: multi-center experience in Korea. Yonsei Med J. 2005. 46:104–111.

12. Stafford-Johnson DB, Wilson TE, Francis IR, Swartz R. CT appearance of sclerosing peritonitis in patients on chronic ambulatory peritoneal dialysis. J Comput Assist Tomogr. 1998. 22:295–299.

13. Fagugli RM, Selvi A, Quintaliani G, Bianchi M, Buoncristiani U. Immunosuppressive treatment for sclerosing peritonitis. Nephrol Dial Transplant. 1999. 14:1343–1345.

14. Junor BJ, McMillan MA. Immunosuppression in sclerosing peritonitis. Adv Perit Dial. 1993. 9:187–189.

15. Bhandari S, Wilkinson A, Sellars L. Sclerosing peritonitis: value of immunosuppression prior to surgery. Nephrol Dial Transplant. 1994. 9:436–437.

16. Kawanishi H, Harada Y, Sakikubo E, Moriishi M, Nagai T, Tsuchiya S. Surgical treatment for sclerosing encapsulating peritonitis. Adv Perit Dial. 2000. 16:252–256.