Paraneoplastic leukocytosis in peritoneal dialysis

Area of Science:

• Oncology
• Nephrology
• Gastroenterology

Background:

• Pancreatic liposarcoma (LPS) is exceptionally rare, with few documented cases.
• Patients on continuous ambulatory peritoneal dialysis (CAPD) are susceptible to infections, complicating diagnosis.

Purpose of the Study:

• To report the first case of primary pancreatic LPS in a patient undergoing CAPD.
• To highlight diagnostic challenges and the importance of considering malignancy in CAPD patients with unexplained symptoms.

Main Methods:

• Case report of a 60-year-old female on CAPD presenting with fever and leukocytosis.
• Diagnostic workup included blood and peritoneal dialysis fluid cultures, imaging (CT scan), and ultrasound-guided fine-needle biopsy.
• Treatment involved empirical antibiotics followed by palliative chemotherapy.

Main Results:

• The patient presented with symptoms mimicking peritoneal dialysis peritonitis, including fever and cloudy dialysate.
• Imaging revealed a large pancreatic tail mass with invasion and metastases.
• Biopsy confirmed dedifferentiated liposarcoma; palliative chemotherapy was initiated.

Conclusions:

• Pancreatic LPS can present atypically in CAPD patients, mimicking infectious peritonitis.
• Malignancy should be considered in the differential diagnosis of fever and leukocytosis in CAPD patients, especially after excluding infection.