Cetin Nuran, Sav Nadide Melike, Ciftci Evrim, Yildiz Bilal
Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Iran J Kidney Dis. 2017 Jul;11(4):319-321.
Foreign body reaction is a tissue response against implanted materials. We described for the first time the eosinophilic peritonitis and foreign body giant cell reaction to dialysis catheter in a nonatopic child on continuous ambulatory peritoneal dialysis. We found tenderness, redness, and swelling without purulent discharge around the peritoneal catheter; increased eosinophil count in cloudy dialysis fluid; and blood and hyperechoic granulomatous formation appearance surrounding the peritoneal catheter on ultrasonography and foreign body giant cell reaction to dialysis catheter in pathologic examination of granulomatous lesionin in our patient. The peritoneal dialysis catheter was removed due to resistance to antibiotic and antihistamine treatments for suspected peritonitis and tunnel infection. Foreign body reaction and eosinophilic peritonitis with eosinophilic cloudy dialysis effluent can exist simultaneously. Foreign body reaction should be considered in the differential diagnosis of exit site and/or tunnel infection. Ultrasonography helps distinguish between foreign body reaction and exit-site or tunnel infection.
异物反应是机体对植入材料的一种组织反应。我们首次描述了一名非特应性儿童在持续非卧床腹膜透析时发生的嗜酸性粒细胞性腹膜炎及对透析导管的异物巨细胞反应。我们发现腹膜导管周围有压痛、发红和肿胀,但无脓性分泌物;浑浊透析液中嗜酸性粒细胞计数增加;超声检查显示腹膜导管周围有血液和高回声肉芽肿形成,病理检查发现肉芽肿病变中有对透析导管的异物巨细胞反应。由于怀疑腹膜炎和隧道感染,经抗生素和抗组胺治疗无效,遂拔除了腹膜透析导管。异物反应和伴有嗜酸性浑浊透析液的嗜酸性粒细胞性腹膜炎可同时存在。在出口部位和/或隧道感染的鉴别诊断中应考虑异物反应。超声有助于区分异物反应与出口部位或隧道感染。