Xu Tian, Xie Jingyuan, Wang Weiming, Ren Hong, Chen Nan
Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Biomed Hub. 2019 Jul 8;4(2):1-7. doi: 10.1159/000500944. eCollection 2019 May-Aug.
A female patient underwent peritoneal dialysis for 2.5 years. She was found to have a constant turbid peritoneal dialysis effluent for 3 months without abdominal pain. Repeated routine tests of peritoneal effluent samples showed an elevated white blood cell count and an increased number of eosinophils. Additionally, a small black spot was found inside the Tenckhoff catheter. The presence of bacteria and fungi was negative by peritoneal fluid culture. Idiopathic eosinophilic peritonitis was considered, and oral corticosteroid treatment was administered. Soon after, the dialysis effluent became clear. However, eosinophilic peritonitis immediately relapsed after the corticosteroid therapy was suspended. Even worse, catheter dysfunction occurred, likely due to a clot that gradually formed from the spot. Finally, the catheter was removed, and a pathological examination was performed. It was revealed that the clot was composed of fungal spores and hyphae as well as eosinophils. This case reminds us that fungal peritonitis should be suspected when a clot forms.
一名女性患者接受了2.5年的腹膜透析。她被发现腹膜透析流出液持续浑浊3个月，无腹痛。反复对腹膜透析液样本进行常规检测显示白细胞计数升高，嗜酸性粒细胞数量增加。此外，在Tenckhoff导管内发现一个小黑点。腹膜液培养细菌和真菌均为阴性。考虑为特发性嗜酸性粒细胞性腹膜炎，并给予口服糖皮质激素治疗。此后不久，透析流出液变清。然而，糖皮质激素治疗暂停后，嗜酸性粒细胞性腹膜炎立即复发。更糟糕的是，导管功能障碍发生，可能是由于从该黑点逐渐形成的血凝块所致。最后，拔除导管并进行病理检查。结果显示血凝块由真菌孢子、菌丝以及嗜酸性粒细胞组成。该病例提醒我们，当形成血凝块时应怀疑真菌性腹膜炎。
