Eosinophilic Peritonitis

Abstract

The development of cloudy peritoneal dialysis effluent is of great concern to the patient undergoing therapy with Continuous Ambulatory Peritoneal Dialysis. As described in this study, not all cloudy fluid represents bacterial infection. We describe the occurrence of cloudy fluid in eight patients in whom culture of the dialysate did not yield any growth, and whose cell count was characterized by the presence of significant numbers of the eosinophiles. As outlined, the entity of eosinophilic peritonitis has a characteristic presentation which allows for its distinction from the more common bacterial peritonitis.

Pathophysiology of Peritoneal Fluid Eosinophilia in Peritoneal Dialysis Patients

“…The differential cell count is characteristic in that there are <60% polymorphonuclear neutrophils and >10% eosinophils. Cultures for microorganisms do not yield any growth and tests for endotoxins are negative [3, 7, 8]. There is no history to suggest a global hypereosinophilic syndrome, allergic disease, parasitic infestation, polyserositis, immunodeficiency syndrome, tuberculosis, malignancy, or connective tissue disease.…”

“…The entity of peritoneal fluid eosinophilia has a characteristic presentation which allows for its distinction from more common bacterial peritonitis [8]. The classic presentation is a cloudy peritoneal fluid, present on an intermittent basis, and may not be seen with every bag exchange (table 1).…”

“…There is no history to suggest a global hypereosinophilic syndrome, allergic disease, parasitic infestation, polyserositis, immunodeficiency syndrome, tuberculosis, malignancy, or connective tissue disease. The peritoneal eosinophilia may last from a few days to several months and usually resolves without peritoneal sequelae [8]. …”

The surgical management of peritoneal dialysis catheters

“…48 There have been reports of non-bacterial, non-specific eosinophilic peritonitis in peritoneal dialysis patients. 49 There is usually an excellent prognosis with resolution within days, 50 although it can lead to encapsulating sclerosing peritonitis in recurrent cases. 51 The causative organisms in peritoneal dialysis peritonitis are generally different to those causing 'surgical peritonitis'.…”

Chronic Inflammatory Demyelinating Polyneuropathy after Initiation of Peritoneal Dialysis – a Distinct Clinical Entity?

“…Back in the early 1980s, it was reported that a certain proportion of patients developed a sterile peritonitis characterized by a predominance of eosinophils in the peritoneal dialysate within 3 months of the initiation of peritoneal dialysis (10)(11)(12). This type of peritonitis was termed eosinophilic peritonitis and was thought to be due to allergy to some constituents of the peritoneal dialysis system.…”