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Splenic infarction: an unrecognized cause of culture-negative peritonitis in a continuous ambulatory peritoneal

C C Yang1, S H Lin, Y H Tzeng

  • 1Division of Nephrology, Department of Medicine, Cheng-Hsin Rehabilitation Medical Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Clinical Nephrology
|November 1, 2007
PubMed

Insights

Culture-negative peritonitis in peritoneal dialysis patients can be caused by spleen infarction. This rare condition requires high suspicion in patients with thromboembolism risk presenting with abdominal pain and cloudy dialysate.

Area of Science:

  • Nephrology
  • Gastroenterology
  • Radiology

Background:

  • Peritonitis is a common complication of peritoneal dialysis (PD).
  • Cloudy dialysate and abdominal pain typically indicate infectious peritonitis, diagnosed via culture.
  • Culture-negative peritonitis necessitates exploring non-infectious intra-abdominal causes.

Observation:

  • A 57-year-old male on continuous ambulatory peritoneal dialysis (CAPD) presented with abdominal pain and cloudy dialysate.
  • Despite empiric antibiotics, symptoms persisted, and all cultures were negative.
  • Abdominal computed tomography revealed isolated spleen infarction.

Findings:

  • Spleen infarction is an uncommon but significant cause of culture-negative peritonitis.
  • This diagnosis is often overlooked in CAPD patients.
  • Patients with a history of thromboembolism risk factors are particularly susceptible.

Implications:

  • Clinicians should consider spleen infarction in CAPD patients with unexplained, persistent, culture-negative cloudy dialysate and abdominal pain.
  • High clinical suspicion is crucial for timely diagnosis and management.
  • Recognizing spleen infarction expands the differential diagnosis for culture-negative peritonitis in PD patients.

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