Diagnostic Dilemma: A Case of Endogenous Peritonitis

Endogenous peritonitis resulting from inflammation or perforation of an abdominal viscus-a result, for example, of diverticulitis, cholecystitis, or acute appendicitis-can be a complication in patients undergoing peritoneal dialysis (PD), with significant morbidity and a high incidence of catheter loss.Here, we describe an end-stage renal disease patient on PD who presented with acute abdominal pain and who was diagnosed with uncomplicated PD peritonitis. His clinical course was complicated by development of eosinophilic peritonitis because of an allergy to vancomycin. Subsequently, when he failed to show clinical improvement, abdominal and pelvic imaging revealed severe appendicitis, which necessitated emergent surgical intervention.