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Two weeks earlier&#44; the patient had been diagnosed with a nasal neoplasm&#46; The results of the peritoneal fluid were&#58; cloudy appearance&#44; 700 leukocytes&#47;&#956;l &#40;80&#37; mononuclear and 20&#37; polymorphonuclear&#41;&#59; despite the predominance of mononuclear leukocytes&#44; we started empiric antibiotic therapy with intraperitoneal ceftazidime and vancomycin&#46; The abdominal examination did not show signs of peritoneal irritation or masses&#59; the peritoneal catheter outlet and tunnel were normal&#46; The blood tests displayed&#58; leukocytes 37&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; platelets 640&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; haemoglobin 10&#46;3g&#47;dl&#44; creatinine 5&#46;4mg&#47;dl&#44; urea 180mg&#47;dl&#44; Na 138mEq&#47;l&#44; K 4mEq&#47;l&#44; calcium 9&#46;5mg&#47;dl&#44; phosphorus 4&#46;8mg&#47;dl&#44; albumin 3&#46;9mg&#47;dl&#46; The peritoneal dialysis cultures taken days later were negative&#46; A computerised axial tomography of the skull&#44; thorax and abdomen was carried out to complete the nasal mass study in the following days&#44; with the results showing scattered mediastinal and retroperitoneal lymphadenopathies&#46; The anatomical pathology of the nasal biopsy was reported as non-Hodgkin lymphoma of large B cells and the cytology of the peritoneal fluid showed atypical lymphocytes&#46; The patient began chemotherapy and remained on PD without further dialysis incidents&#46;</p><p class="elsevierStylePara">The presence of abdominal pain associated with cloudy peritoneal fluid in a PD patient is generally associated with peritonitis&#46; For the diagnosis of bacterial peritonitis&#44; at least two of the following three conditions are required&#58; abdominal pain alone or accompanied by other abdominal symptoms&#44; peritoneal fluid with more than 100 leukocytes&#47;&#956;l&#44; with more than 50&#37; being polymorphonuclear&#44; and the culture or Gram stain showing the existence of micro-organisms<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara">It is difficult to distinguish between a peritoneal infection with a negative culture and non-infectious peritoneal inflammation &#40;sterile peritonitis&#41;&#46; A negative peritoneal culture is generally due to technical failures in the processing of samples&#44; and as such&#44; management is complicated given that there is infectious peritonitis without bacterial growth in the culture&#46; It is advised to revise the culture technique when the latter is negative in more than 20&#37; of occasions and ask the patient about previous use of antibiotics<span class="elsevierStyleSup">2</span>&#46; To achieve a quick diagnosis in cases of sterile peritonitis&#44; the Spanish PD guidelines give a general outline&#44; taking into account the presence or absence of cells in the peritoneal fluid and the type of cells&#46; An increase in polymorphonuclear cells may be due to inflammation of the viscera within or around the peritoneum&#44; medication or peritoneal fluid that is contaminated by endotoxins&#46; If eosinophils increase&#44; we must suspect an allergic reaction to the dialysis material&#44; medication and peritoneal irritation due to retrograde blood or after peritonitis due to fungi and parasites&#46; An increase in mononuclear cells may be associated with icodextrin or infection due to mycobacteria or fungi&#46; If there are also red blood cells&#44; the following must be considered&#58; ovulation&#44; retrograde menstruation&#44; ovarian cyst rupture&#44; hypertonic solution&#44; peritoneal adhesions&#44; physical exercise and catheter-induced trauma&#46; When there is a high number of mononuclear and malignant cells&#44; we must consider lymphoma or peritoneal metastases&#46; However&#44; an absence of cells may be due to an increase in fibrin or triglycerides<span class="elsevierStyleSup">3&#44;4</span>&#46;</p><p class="elsevierStylePara">The literature reports some cases of suspected peritonitis in PD associated with tumour processes&#44; amongst them a patient with recurrent renal cell carcinoma diagnosed in the peritoneal fluid cytology<span class="elsevierStyleSup">5</span>&#46; Another patient had sterile peritonitis with a history of lymphoma diagnosed ten years earlier&#46; The peritoneal fluid cytology allowed atypical lymphocytes to be observed and&#44; as in our case&#44; despite peritoneal invasion&#44; the patient continued with the PD technique<span class="elsevierStyleSup">6</span>&#46;</p><p class="elsevierStylePara">In conclusion&#44; we must highlight that in the differential diagnosis of sterile peritonitis&#44; we must not forget the potential existence of a neoplastic process&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p>"
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Non-Hodgkin lymphoma mimicking peritonitis in a patient on peritoneal dialysis
Linfoma no-Hodgkin simulando una peritonitis en un paciente en diálisis peritoneal
Margarita Delgado-Córdovaa, Juan C. Peñalozab, Agustín Fuentesc, Francisco Coroneld
a Servicio de Nefrología. Departamento de Medicina, Universidad Autónoma de Chile. Universidad Católica del Maule. Chile,
b Servicio de Nefrología. Departamento de Medicina, Universidad Autónoma de Chile. Universidad Católica del Maule, Chile,
c Servicio de Nefrología, Hospital de Talca, Chile,
d Ex-jefe de sección, Hospital Clínico San Carlos, España,
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Two weeks earlier&#44; the patient had been diagnosed with a nasal neoplasm&#46; The results of the peritoneal fluid were&#58; cloudy appearance&#44; 700 leukocytes&#47;&#956;l &#40;80&#37; mononuclear and 20&#37; polymorphonuclear&#41;&#59; despite the predominance of mononuclear leukocytes&#44; we started empiric antibiotic therapy with intraperitoneal ceftazidime and vancomycin&#46; The abdominal examination did not show signs of peritoneal irritation or masses&#59; the peritoneal catheter outlet and tunnel were normal&#46; The blood tests displayed&#58; leukocytes 37&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; platelets 640&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; haemoglobin 10&#46;3g&#47;dl&#44; creatinine 5&#46;4mg&#47;dl&#44; urea 180mg&#47;dl&#44; Na 138mEq&#47;l&#44; K 4mEq&#47;l&#44; calcium 9&#46;5mg&#47;dl&#44; phosphorus 4&#46;8mg&#47;dl&#44; albumin 3&#46;9mg&#47;dl&#46; The peritoneal dialysis cultures taken days later were negative&#46; A computerised axial tomography of the skull&#44; thorax and abdomen was carried out to complete the nasal mass study in the following days&#44; with the results showing scattered mediastinal and retroperitoneal lymphadenopathies&#46; The anatomical pathology of the nasal biopsy was reported as non-Hodgkin lymphoma of large B cells and the cytology of the peritoneal fluid showed atypical lymphocytes&#46; The patient began chemotherapy and remained on PD without further dialysis incidents&#46;</p><p class="elsevierStylePara">The presence of abdominal pain associated with cloudy peritoneal fluid in a PD patient is generally associated with peritonitis&#46; For the diagnosis of bacterial peritonitis&#44; at least two of the following three conditions are required&#58; abdominal pain alone or accompanied by other abdominal symptoms&#44; peritoneal fluid with more than 100 leukocytes&#47;&#956;l&#44; with more than 50&#37; being polymorphonuclear&#44; and the culture or Gram stain showing the existence of micro-organisms<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara">It is difficult to distinguish between a peritoneal infection with a negative culture and non-infectious peritoneal inflammation &#40;sterile peritonitis&#41;&#46; A negative peritoneal culture is generally due to technical failures in the processing of samples&#44; and as such&#44; management is complicated given that there is infectious peritonitis without bacterial growth in the culture&#46; It is advised to revise the culture technique when the latter is negative in more than 20&#37; of occasions and ask the patient about previous use of antibiotics<span class="elsevierStyleSup">2</span>&#46; To achieve a quick diagnosis in cases of sterile peritonitis&#44; the Spanish PD guidelines give a general outline&#44; taking into account the presence or absence of cells in the peritoneal fluid and the type of cells&#46; An increase in polymorphonuclear cells may be due to inflammation of the viscera within or around the peritoneum&#44; medication or peritoneal fluid that is contaminated by endotoxins&#46; If eosinophils increase&#44; we must suspect an allergic reaction to the dialysis material&#44; medication and peritoneal irritation due to retrograde blood or after peritonitis due to fungi and parasites&#46; An increase in mononuclear cells may be associated with icodextrin or infection due to mycobacteria or fungi&#46; If there are also red blood cells&#44; the following must be considered&#58; ovulation&#44; retrograde menstruation&#44; ovarian cyst rupture&#44; hypertonic solution&#44; peritoneal adhesions&#44; physical exercise and catheter-induced trauma&#46; When there is a high number of mononuclear and malignant cells&#44; we must consider lymphoma or peritoneal metastases&#46; However&#44; an absence of cells may be due to an increase in fibrin or triglycerides<span class="elsevierStyleSup">3&#44;4</span>&#46;</p><p class="elsevierStylePara">The literature reports some cases of suspected peritonitis in PD associated with tumour processes&#44; amongst them a patient with recurrent renal cell carcinoma diagnosed in the peritoneal fluid cytology<span class="elsevierStyleSup">5</span>&#46; Another patient had sterile peritonitis with a history of lymphoma diagnosed ten years earlier&#46; The peritoneal fluid cytology allowed atypical lymphocytes to be observed and&#44; as in our case&#44; despite peritoneal invasion&#44; the patient continued with the PD technique<span class="elsevierStyleSup">6</span>&#46;</p><p class="elsevierStylePara">In conclusion&#44; we must highlight that in the differential diagnosis of sterile peritonitis&#44; we must not forget the potential existence of a neoplastic process&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p>"
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                  "referenciaCompleta" => "Streather CP, Carr P, Barton IK. Carcinoma of the kidney presenting as a sterile peritonitis in a patient on continuous ambulatory peritoneal dialysis. Nephron 1991;58:121. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1857472" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Vlahakos D, Rudders R, Simon G, Canzanello V. Lymphoma-mimicking peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int 1990;10:165-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2085602" target="_blank">[Pubmed]</a>"
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Article information
ISSN: 20132514
Original language: English
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Idiomas
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