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Lymphoma-mimicking peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD)
D Vlahakos1, R Rudders, G Simon
1Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
Abstract:
Cloudy dialysate in a patient on continuous ambulatory peritoneal dialysis (CAPD) most commonly reflects an increased number of leukocytes secondary to bacterial peritonitis. In the absence of infection, increased quantities of eosinophils, red blood cells, fibrin, or chyle may produce cloudy dialysate in these patients. We report the case of a CAPD patient presenting with cloudy dialysate and symptoms suggestive of bacterial peritonitis. Analysis of the dialysate revealed no microorganisms. The turbidity of the dialysate was related to an increased number of atypical lymphocytes consistent with a B cell lymphoma. Peritoneal dialysis continued uneventfully despite neoplastic disease within the peritoneum. It is recommended that malignant involvement of the peritoneum be added to the differential diagnosis of cloudy dialysate occurring in CAPD patients.
Insights
Cloudy dialysate in continuous ambulatory peritoneal dialysis (CAPD) can indicate infection. However, atypical lymphocytes from B cell lymphoma can also cause cloudy dialysate, even without infection.
Area of Science:
- Nephrology
- Oncology
- Peritoneal Dialysis
Background:
- Cloudy dialysate in continuous ambulatory peritoneal dialysis (CAPD) typically suggests bacterial peritonitis.
- Other causes include eosinophils, red blood cells, fibrin, or chyle.
Observation:
- A CAPD patient presented with cloudy dialysate and symptoms mimicking bacterial peritonitis.
- Dialysate analysis revealed no microorganisms but showed atypical lymphocytes.
Findings:
- The cloudy dialysate was attributed to an increased number of atypical lymphocytes.
- These lymphocytes were consistent with a B cell lymphoma.
Implications:
- Malignant involvement of the peritoneum should be considered in the differential diagnosis of cloudy dialysate in CAPD patients.
- Peritoneal dialysis can be continued safely even with neoplastic disease in the peritoneum.