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Herpes simplex peritonitis: case report
1Department of Pathology, Saint Francis Medical Center, Pittsburgh, Pennsylvania 15201, USA. cacy777@aol.com
Abstract:
It has been previously reported that the most common cause of peritonitis in patients undergoing chronic ambulatory peritoneal dialysis (CAPD) is infection by a single gram-positive bacterial species. Polymicrobial bacterial infections are identified that may be secondary to bowel perforation. In 20% of cases bacterial cultures are negative. Although cultures may be negative when infection is due to a fastidious organism, when antibiotic therapy has been administered, and in cases of chemical peritonitis, a viral etiology should also be considered. We report the first documented case of herpes simplex peritonitis, which involved a 60-year-old female undergoing CAPD. Viral peritonitis may be an important form of peritonitis that has been previously unrecognized and should be considered in the differential diagnosis.
Insights
Peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients can be caused by viruses, not just bacteria. This case highlights herpes simplex virus as a potential cause of peritonitis, previously unrecognized.
Area of Science:
- Nephrology
- Infectious Diseases
- Virology
Background:
- Peritonitis is a common complication in patients undergoing chronic ambulatory peritoneal dialysis (CAPD).
- Typically, gram-positive bacterial infections are the most frequent cause of CAPD peritonitis.
- Negative bacterial cultures occur in a significant percentage of cases.
Observation:
- A 60-year-old female undergoing CAPD presented with peritonitis.
- Herpes simplex virus was identified as the causative agent.
- This represents the first documented case of herpes simplex peritonitis in a CAPD patient.
Findings:
- Viral etiologies, such as herpes simplex virus, should be considered in CAPD peritonitis, especially with negative bacterial cultures.
- Negative cultures can occur with fastidious organisms, prior antibiotic use, or chemical peritonitis, masking viral causes.
- Herpes simplex peritonitis may be an underdiagnosed cause of peritonitis in CAPD patients.
Implications:
- The differential diagnosis for CAPD peritonitis should include viral infections.
- Recognizing viral peritonitis can lead to earlier and more appropriate treatment.
- Further investigation into viral causes of peritonitis in CAPD patients is warranted.