Severe eosinophilic peritonitis caused by intraperitoneal vancomycin administration

Clin Nephrol. 2021 Sep;96(3):184-187. doi: 10.5414/CN110400.

Abstract

Unlike infectious peritonitis, non-infectious eosinophilic peritonitis (EP) in uremic patients on continuous ambulatory peritoneal dialysis (CAPD) still goes unrecognized, leading to inappropriate management. We report a 56-year-old male with uremia on CAPD exhibiting peritonitis with abdominal pain, fever, and turbid dialysate containing increasing WBCs with neutrophils predominant and growing Enterococcus faecalis. Intraperitoneal vancomycin 100 mg administration in each peritoneal dialysis (PD) bag exchange improved clinical and laboratory features initially. However, recurrent turbid dialysate with prominent eosinophils (25%) but negative culture appeared on the 5th day. Despite continuous intraperitoneal vancomycin, persistent turbid dialysate with prominent eosinophils (77%) was notable with peripheral eosinophilia (28%). With the cessation of intraperitoneal vancomycin and the use of oral steroid therapy, EP and eosinophilia completely resolved. Antibiotics (vancomycin)-induced eosinophilic peritonitis should be kept in mind as a cause of recurrent turbid dialysate with higher percentage of eosinophils and negative cultures to avoid unnecessary examination and complication.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Peritoneal Dialysis*
  • Peritoneal Dialysis, Continuous Ambulatory* / adverse effects
  • Peritonitis* / chemically induced
  • Peritonitis* / diagnosis
  • Peritonitis* / drug therapy
  • Vancomycin / adverse effects

Substances

  • Anti-Bacterial Agents
  • Vancomycin