The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 341
Poster Session
PS 1348 Nephrology
Unusual Capd Peritonitis by Citrobacter Freundii Com- plicating with Fungal Infection Identifi ed by 16s Ribo- somal RNA Gene Sequencing
Tae Ryom Oh1, Seong Kwon Ma1, Soo Wan Kim1 Chonnam National University Hospital, Korea1
We present a rare case of continuous ambulatory peritoneal dialysis peritonitis by Citrobacter freundii complicating fungal infection with abscess formation. A 34-year- old woman was admitted our hospital with complaint of abdominal pain and turbid peritoneal dialysate. Culture studies were performed for identifi cation of pathogen, it isolate was confi rmed as Citrobacter freundii by using DNA sequencing of the 16s ribosomal RNA. Antibiotics therapy alone was not effective in her hospital course, she was recovered after removal of peritoneal catheter and drainage of abscess. Citrobac- ter species are unusual pathogens of peritonitis, it shows poor outcomes. Also fungal peritonitis is a serious complication of bacterial peritonitis, early diagnosis will reduce morbidity and mortality. Indwelling catheters should be removed, appropriate antibi- otics therapy based on anti-biogram test is needed for management. Careful suspicion of complication of fungal infection in bacterial peritonitis will improve the prognosis of patients who undergoing peritoneal dialysis.
PS 1349 Nephrology
Post-Transplant Encapsulating Peritoneal Sclerosis : Patient Undergoing Peritoneal Dialysis for 19 Years
Seong Han Yun1, Joong-Kyung Kim1, Jin Ho Lee1, Joon Seok Oh1, Jung Min Kim1, Yong Hun Sin1
Bongseng Hospital, Korea1
Encapsulating peritoneal sclerosis (EPS) is rare but serious complication in patients on peritoneal dialysis (PD). Traditional risk factors for EPS are prolonged PD, recent cessation of PD, use of dialysis solutions with lower bio-compatibility and peritonitis episodes. We present a case of a 49-year-old female patient with kidney transplanted 9 months ago. She was admitted with complaints of persistent nausea and abdominal discomfort. Diagnostic laparoscopy was performed with biopsy. This showed that the small bowel was cocooned in the center of the abdominal cavity by a thick fi brous layer. A peritoneal biopsy was associated with fi brous tissue and calcifi cation. Com- puted tomography (CT) scan with contrast was performed. This showed a large volume of ascites, distension of small bowel, thickening, calcifi cation and enhancement of the peritoneal membrane. Tamoxifen (20 mg/day, per-oral) therapies were started with parenteral nutrition. She was able to tolerate an oral intake after laparoscopy with fl uid resorption. One month later, she was admitted for paracentesis, due to abdominal distension. Three months later, medical treatment is continued and decreased ascites, abdominal discomfort and nausea. CRP is decreased (0.34 mg/dl). Serum albumin is normal values (3.9 g/dl) and improving nutritional status. But, follow up CT showed thickening and calcifi cation of the peritoneal membrane and small bowel distension.
We report a case of patient with EPS that switched kidney transplantation from long term PD and treated by tamoxifen, low dose corticosteroid.
PS 1350 Nephrology
A Case of Early Encapsulating Peritoneal Sclerosis Suc- cessfully Treated with Steroid Monotherapy
Sae-In Kim1, Shina Lee1, Seung-Jung KIM1, Duk-Hee Kang1, Dong-Ryeol Ryu1, Kyu- Bok Choi1
Department of Internal Medicine, School of Medicine, Ewha Womans University, Korea1
Encapsulating peritoneal sclerosis(EPS) is a serious and often fatal complication of long-term peritoneal dialysis(PD). It is characterized by the presence of an infl amma- tory reaction and diffuse peritoneal membrane fi brosis, which develops into bowel encapsulation and peritoneal calcification, and manifests as clinical symptoms of intestinal obstruction. Initial treatment is discontinuation of PD and supportive care.
Then surgical adhesiolysis can be considered in late phase, but the prognosis is poor after operation. Therefore, anti-infl ammatory therapy likewise corticosteroid in early phase could be more important in improving prognosis because it may be able to suppress peritoneal infl ammatory process and inhibit synthesis of collagen. Hereby, we describe a patients diagnosed with early EPS and successfully treated with steroid monotherapy. A 53-year-old man who had started peritoneal dialysis 7 years ago was transfered to hemodialysis due to recurrent CAPD related peritonitis. Six months after switching dialysis modality, he complained of abdominal distension with shifting dull- ness on physical examination, suggesting ascites. On the abdominal CT scan, massive ascites and peritoneal enhancement were observed rather than peritoneal calcifi cation and intestinal obstruction. Moreover, peritoneal biopsy showed chronic infl ammation with granulation tissue and fi brosis. Taken together, he was diagnosed with early EPS and glucocorticosteroids were described for 1 year. Finally, following CT scan showed complete resolvation of ascites and the symptoms were subsided.
