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Persistent exit-site infection in peritoneal dialysis - An unrecognized window to abdominal viscera

Ana Teresa Domingos1, Anabela Malho Guedes1, Filipa Brito Mendes1

  • 1Serviço de Nefrologia, 466964Centro Hospitalar do Algarve, Faro, Portugal.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|April 24, 2020
PubMed

Insights

A peritoneal dialysis catheter exit-site infection was found to be a rare metastasis pathway for an unknown pancreatic cancer. Catheter removal was crucial for diagnosing this advanced adenocarcinoma.

Area of Science:

  • Nephrology
  • Oncology
  • Pathology

Background:

  • Exit-site (ES) infections are common in peritoneal dialysis (PD) patients.
  • Pseudomonas spp. infections are challenging and may necessitate catheter removal.
  • Chronic ES infections can present diagnostic challenges.

Purpose of the Study:

  • To report a rare case of peritoneal dialysis catheter-related exit-site infection.
  • To highlight the diagnostic role of catheter removal in identifying underlying malignancy.
  • To describe a unique presentation of pancreatic adenocarcinoma metastasis.

Main Methods:

  • Case report of a patient with chronic, antibiotic-resistant exit-site infection.
  • Surgical removal of the peritoneal dialysis catheter.
  • Histopathological examination of removed tissue.
  • Abdominal computed tomography (CT) scan for staging.

Main Results:

  • Histology revealed well-differentiated adenocarcinoma infiltrating the catheter tract.
  • CT scan identified a primary pancreatic tail lesion and widespread metastases.
  • The exit-site infection was determined to be a metastatic pathway for pancreatic cancer.
  • Catheter removal facilitated the diagnosis of malignancy.

Conclusions:

  • Peritoneal dialysis catheter-related infections can, in rare instances, represent metastatic cancer.
  • Catheter removal can be critical for diagnosing occult malignancies presenting as infectious complications.
  • This case underscores the importance of thorough investigation in refractory exit-site infections.
Keywords:
Exit-site infectionpancreatic cancerpseudomonasskin metastasis

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