Encapsulating peritoneal sclerosis associated with Burkholderia pseudomallei peritonitis

Area of Science:

• Infectious Diseases
• Nephrology
• Microbiology

Background:

• Melioidosis, caused by Burkholderia pseudomallei, is an infectious disease endemic in tropical regions, typically affecting immunocompromised individuals.
• End-stage renal disease (ESRD) patients on peritoneal dialysis (PD) are at increased risk for infectious complications.
• Peritonitis is a common complication in PD patients, often caused by bacterial infections.

Observation:

• A rare case of a patient with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD) who presented with melioidosis peritonitis.
• The patient rapidly developed encapsulating peritoneal sclerosis (EPS), a severe complication characterized by intraabdominal cocooning.
• Burkholderia pseudomallei was identified as the causative agent of the peritonitis.

Findings:

• This report details a unique presentation of melioidosis in a CAPD patient, leading to severe outcomes including peritonitis and EPS.
• The study underscores the potential for unusual pathogens like Burkholderia pseudomallei to cause serious infections in PD patients.
• Intraoperative findings confirmed intraabdominal cocooning, indicative of advanced encapsulating peritoneal sclerosis.

Implications:

• Early diagnosis and prompt, appropriate antibiotic treatment are crucial for managing melioidosis peritonitis and preventing complications like EPS in PD patients.
• This case highlights the importance of considering melioidosis in the differential diagnosis of peritonitis in PD patients, especially in endemic areas.
• Optimizing antibiotic choice and duration is critical for successful eradication of Burkholderia pseudomallei and improving patient prognosis.