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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis is a rare complication of peritoneal dialysis &#40;PD&#41;&#46; One of its variants&#44; fulminant sclerosing peritonitis &#40;FSP&#41;&#44; evolves in a hyperacute form after an episode of bacterial peritonitis&#46; It is a clinical profile regarded with a high index of suspicion and early initiation of steroid treatment&#44; which usually gives a positive&#44; quick and dramatic response&#46; We describe 5 FSP cases with significant clinical improvement after steroid therapy&#46;</p><p class="elsevierStylePara">We reviewed the medical records of 164 patients receiving PD in Neuqu&#233;n&#44; Argentina&#44; between 1996 and 2008&#46; Nine of them had symptoms compatible with encapsulating peritoneal sclerosis &#40;5&#46;38&#37;&#41;&#44; five of whom corresponded to the variant EPS&#46; Four were women&#44; with an average age of 40 years&#44; PET average low&#44; average high or high&#59; time on PD 3-7 years&#44; 2 patients with a previous history of peritonitis&#46; All had episodes of peritonitis to common germs immediately before the reference symptoms&#44; which is usually characterised by severe impairment&#44; bloating&#44; abdominal pain&#44; fever&#44; diarrhoea&#44; intestinal hypomotility and vomiting&#46; Complementary studies &#40;CT&#41;&#58; variable peritoneal thickening&#44;&#160; adhesions&#44; calcium deposits&#44; loculations&#44; fibrous tracts&#44; blurring of fat&#46; Some were normal&#46;</p><p class="elsevierStylePara">Initial therapy&#58; ATB according to sensitivity&#44; catheter extraction&#44; laparotomy and extensive washing&#46;</p><p class="elsevierStylePara">Evolution&#58; severely affected&#44; systemic inflammatory response syndrome &#40;SIRS&#41; without response to treatment&#46; One patient developed distributive shock and required mechanical ventilation&#46;</p><p class="elsevierStylePara">Peritoneal biopsies &#40;3 cases&#41;&#58; variable peritoneal thickening&#44; hyalinosis&#44; calcifications&#44; necrosis&#44; abscesses&#44; fibrosis&#44; inflammatory infiltrates&#44; consistent with sclerosing peritonitis&#46;</p><p class="elsevierStylePara">Prednisolone was given to all patients p&#46;o&#46; 1mg&#47;kg&#47;day or IV methylprednisolone pulses&#44; with immediate noticeable improvement in the clinical profile&#46; One patient had gastrointestinal bleeding&#44; was changed to sirolimus and died from hospital pneumonia after the abdominal profile was resolved&#46;</p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis is a serious complication of PD&#46; Early reports considered it lethal&#46;<span class="elsevierStyleSup">1</span> The prevalence varies according to different authors&#44; from 0&#46;7&#37; increasing during treatment to reach 19&#46;4&#37; in those with more than 8 years&#46;<span class="elsevierStyleSup">2</span> Among the risk factors are the following&#58; time on PD&#44;<span class="elsevierStyleSup">2</span> severe peritonitis&#44; and especially infection by&#160; <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; fungi and <span class="elsevierStyleItalic">Pseudomonas</span>&#44; the number and severity of each episode<span class="elsevierStyleSup">3-5</span> and solutions with a high glucose content&#46; A large percentage of cases developed slowly after stopping PD and transferring to HD&#46;<span class="elsevierStyleSup">4</span> In other cases&#44; a continuation of severe bacterial peritonitis followed&#44; as a second phase phenomenon&#44; and acquired the features of fulminant sclerosing peritonitis&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">The term sclerosing peritonitis is used to demonstrate the infectious component&#47;acute inflammation shown&#44; and the expression encapsulating peritoneal sclerosis to describe a slow and progressive form of the disease&#46;</p><p class="elsevierStylePara">We used immunosuppressive treatment in 5 patients with FSP&#44; with a dramatic remission in the symptoms and normalisation of the intestinal transit in less than 72 h&#46; There was only one death&#44; after resolution of the abdominal profile&#44; due to lung intercurrences&#46;</p><p class="elsevierStylePara">Treatment lasted for 6 months&#44; in decreasing doses until reaching 20mg&#47;day of prednisolone&#46; It was subsequently suspended&#44; without recurrence of the clinical profile&#46; The patients are still alive&#44; with a follow-up between 2 and 6 years in haemodialysis&#44; and one patient has undergone transplantation&#46;</p><p class="elsevierStylePara">We conclude that patients with an apparent diagnosis of sepsis associated with primary peritonitis in PD&#44; abdominal signs without remission and negative cultures&#44; must have FSP considered as a diagnosis and early initiation of steroid treatment evaluated&#46; This may save the life of a patient&#46;</p>"
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Fulminant sclerosing peritonitis: dramatic response to steroid treatment
Peritonitis esclerosante fulminante. Espectacular respuesta al tratamiento con esteroides
I.. Hendela, Sonia Mastrapasquaa, C.. Martíneza, F.. Martíneza, O.. Escobara
a Servicio de Nefrología, Hospital Provincial Neuquén, Neuquén, Argentina,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis is a rare complication of peritoneal dialysis &#40;PD&#41;&#46; One of its variants&#44; fulminant sclerosing peritonitis &#40;FSP&#41;&#44; evolves in a hyperacute form after an episode of bacterial peritonitis&#46; It is a clinical profile regarded with a high index of suspicion and early initiation of steroid treatment&#44; which usually gives a positive&#44; quick and dramatic response&#46; We describe 5 FSP cases with significant clinical improvement after steroid therapy&#46;</p><p class="elsevierStylePara">We reviewed the medical records of 164 patients receiving PD in Neuqu&#233;n&#44; Argentina&#44; between 1996 and 2008&#46; Nine of them had symptoms compatible with encapsulating peritoneal sclerosis &#40;5&#46;38&#37;&#41;&#44; five of whom corresponded to the variant EPS&#46; Four were women&#44; with an average age of 40 years&#44; PET average low&#44; average high or high&#59; time on PD 3-7 years&#44; 2 patients with a previous history of peritonitis&#46; All had episodes of peritonitis to common germs immediately before the reference symptoms&#44; which is usually characterised by severe impairment&#44; bloating&#44; abdominal pain&#44; fever&#44; diarrhoea&#44; intestinal hypomotility and vomiting&#46; Complementary studies &#40;CT&#41;&#58; variable peritoneal thickening&#44;&#160; adhesions&#44; calcium deposits&#44; loculations&#44; fibrous tracts&#44; blurring of fat&#46; Some were normal&#46;</p><p class="elsevierStylePara">Initial therapy&#58; ATB according to sensitivity&#44; catheter extraction&#44; laparotomy and extensive washing&#46;</p><p class="elsevierStylePara">Evolution&#58; severely affected&#44; systemic inflammatory response syndrome &#40;SIRS&#41; without response to treatment&#46; One patient developed distributive shock and required mechanical ventilation&#46;</p><p class="elsevierStylePara">Peritoneal biopsies &#40;3 cases&#41;&#58; variable peritoneal thickening&#44; hyalinosis&#44; calcifications&#44; necrosis&#44; abscesses&#44; fibrosis&#44; inflammatory infiltrates&#44; consistent with sclerosing peritonitis&#46;</p><p class="elsevierStylePara">Prednisolone was given to all patients p&#46;o&#46; 1mg&#47;kg&#47;day or IV methylprednisolone pulses&#44; with immediate noticeable improvement in the clinical profile&#46; One patient had gastrointestinal bleeding&#44; was changed to sirolimus and died from hospital pneumonia after the abdominal profile was resolved&#46;</p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis is a serious complication of PD&#46; Early reports considered it lethal&#46;<span class="elsevierStyleSup">1</span> The prevalence varies according to different authors&#44; from 0&#46;7&#37; increasing during treatment to reach 19&#46;4&#37; in those with more than 8 years&#46;<span class="elsevierStyleSup">2</span> Among the risk factors are the following&#58; time on PD&#44;<span class="elsevierStyleSup">2</span> severe peritonitis&#44; and especially infection by&#160; <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; fungi and <span class="elsevierStyleItalic">Pseudomonas</span>&#44; the number and severity of each episode<span class="elsevierStyleSup">3-5</span> and solutions with a high glucose content&#46; A large percentage of cases developed slowly after stopping PD and transferring to HD&#46;<span class="elsevierStyleSup">4</span> In other cases&#44; a continuation of severe bacterial peritonitis followed&#44; as a second phase phenomenon&#44; and acquired the features of fulminant sclerosing peritonitis&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">The term sclerosing peritonitis is used to demonstrate the infectious component&#47;acute inflammation shown&#44; and the expression encapsulating peritoneal sclerosis to describe a slow and progressive form of the disease&#46;</p><p class="elsevierStylePara">We used immunosuppressive treatment in 5 patients with FSP&#44; with a dramatic remission in the symptoms and normalisation of the intestinal transit in less than 72 h&#46; There was only one death&#44; after resolution of the abdominal profile&#44; due to lung intercurrences&#46;</p><p class="elsevierStylePara">Treatment lasted for 6 months&#44; in decreasing doses until reaching 20mg&#47;day of prednisolone&#46; It was subsequently suspended&#44; without recurrence of the clinical profile&#46; The patients are still alive&#44; with a follow-up between 2 and 6 years in haemodialysis&#44; and one patient has undergone transplantation&#46;</p><p class="elsevierStylePara">We conclude that patients with an apparent diagnosis of sepsis associated with primary peritonitis in PD&#44; abdominal signs without remission and negative cultures&#44; must have FSP considered as a diagnosis and early initiation of steroid treatment evaluated&#46; This may save the life of a patient&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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