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2021 May 27

Clin Nephrol

Severe eosinophilic peritonitis caused by intraperitoneal vancomycin administration.



Unlike infectious peritonitis, non-infectious eosinophilic peritonitis (EP) in uremic patients on continuous ambulatory peritoneal dialysis (CAPD) still goes unrecognized, leading to inappropriate management. We report a 56-year-old male with uremia on CAPD exhibiting peritonitis with abdominal pain, fever, and turbid dialysate containing increasing WBCs with neutrophils predominant and growing . Intraperitoneal vancomycin 100 mg administration in each peritoneal dialysis (PD) bag exchange improved clinical and laboratory features initially. However, recurrent turbid dialysate with prominent eosinophils (25%) but negative culture appeared on the 5th day. Despite continuous intraperitoneal vancomycin, persistent turbid dialysate with prominent eosinophils (77%) was notable with peripheral eosinophilia (28%). With the cessation of intraperitoneal vancomycin and the use of oral steroid therapy, EP and eosinophilia completely resolved. Antibiotics (vancomycin)-induced eosinophilic peritonitis should be kept in mind as a cause of recurrent turbid dialysate with higher percentage of eosinophils and negative cultures to avoid unnecessary examination and complication.