Clearing the clouds: Case-report and review of the literature.

Clearing the clouds: Case-report and review of the literature.
Semin Dial. 2020 Nov 02;:
Authors: Relvas M, Beco A, Pereira L, Oliveira A, Silvano J, Silva R, Marques N, Santos L, Coentrão L, Pestana M
Abstract
In peritoneal dialysis (PD), a cloudy dialysate is an alarming finding. Bacterial peritonitis is the most common cause, however, atypical infections and non-infectious causes must be considered. A 46-year-old man presented with asthenia, paraesthesia, foamy urine and hypertension. Laboratory testing revealed severe azotaemia, anaemia, hyperkalaemia and nephrotic-range proteinuria. Haemodialysis was started through a central venous catheter. Later, due to patient preference, a Tenckhoff catheter was inserted. Conversion to PD occurred 3 weeks later, during hospitalization for a presumed central line infection. A month later, the patient was hospitalized for neutropenic fever. He was diagnosed an acute parvovirus infection and was discharged under isoniazid for latent tuberculosis. Four months later, the patient presented with fever and a cloudy effluent. Peritoneal fluid (PF) cytology was suggestive of infectious peritonitis, but the symptoms persisted despite antibiotic therapy. Bacterial and mycological cultures were negative. No neoplastic cells were detected. Mycobacterium tuberculosis eventually grew in PF cultures, despite previous negative molecular tests. Directed therapy was then initiated with excellent response. Th...

Source: Seminars in Dialysis - November 2, 2020 Category: Urology & Nephrology Authors: Relvas M, Beco A, Pereira L, Oliveira A, Silvano J, Silva R, Marques N, Santos L, Coentrão L, Pestana M Tags: Semin Dial Source Type: research