Cloudy Dialysate as the Initial Presentation for Lymphoma

Area of Science:

• Nephrology
• Gastroenterology
• Oncology

Background:

• Turbid dialysate in peritoneal dialysis (PD) patients typically suggests peritonitis, leading to empirical antibiotic treatment.
• Culture-negative turbid fluid necessitates exploring alternative diagnoses beyond infection.

Observation:

• A patient on peritoneal dialysis presented with turbid dialysate, initially treated empirically for peritonitis.
• Standard cultures of the dialysate fluid were negative, prompting further investigation.

Findings:

• Analysis of the dialysate fluid revealed chylous ascites, characterized by high triglyceride levels and the presence of chylomicrons.
• Subsequent investigations, including imaging and biopsy, confirmed an underlying malignancy as the cause of chylous ascites.

Implications:

• This case highlights the importance of considering non-infectious etiologies, such as malignancy-induced chylous ascites, in PD patients with culture-negative turbid dialysate.
• Prompt and thorough investigation of atypical presentations can lead to timely diagnosis and management of serious underlying conditions.