Severe eosinophilic pneumonia during the initiation of peritoneal dialysis：a case report and literature review

Abstract

Keywords： eosinophilic pneumonia, peritoneal dialysis, hemodialysis, allergy 〈Abstract〉 A 79 year old male with end stage renal disease due to IgA nephropathy was admitted to hospital so that peritoneal dialysis (PD) could be initiated. He had undergone PD catheter insertion four months earlier. An exit site was created, and he started undergoing PD using glucose based PD solutions. Ten days after the initiation of PD, he developed a cough and fever. He was diagnosed with pneumonia, but antibiotics were ineffective. Bronchoscopy revealed marked eosinophilia (67％) in his bronchoalveolar lavage fluid, and a diagnosis of eosinophilic pneumonia (EP) was confirmed. It was considered unlikely that the EP had been caused by drugs or environmental factors. Instead, we suspected that the dialysate or PD catheter had triggered the onset of EP. Non invasive positive pressure ventilation and transient hemodialysis (HD) were needed. However, after high dose steroid therapy, his symptoms immediately improved, although he still needed home oxygen therapy. After his condition improved, he hoped to resume PD until he was discharged. He resumed PD without any recurrence of the EP until discharge. He was subsequently readmitted for vertebral compression fractures. His pneumonia relapsed during steroid tapering. He died of respiratory failure despite intensive treatment. Only four cases of PD associated EP have been reported. In all of these cases, the patients were successfully treated with steroids or the removal of the suspected cause, and PD was resumed without the EP going into remission. However, when such patients are in incomplete remission, we should consider transitioning from PD to HD because relapsed pneumonia can be fatal.