Back
Eosinophilic Peritonitis (EP) is a non-infectious complication associated with peritoneal dialysis (PD) treatment, which is defined by the presence of >100 eosinophils/mm3 or >10% eosinophils in the total leukocyte count of the PD effluent; in the presence of negative peritoneal fluid cultures and symptoms suggestive of peritonitis, which may or may not present with peripheral eosinophilia. It is probably induced by chemical stimuli that pass through the catheter and has an incidence that varies from 16 to 60%.
Neuroendocrine tumors as primary malignant neoplasms of the cecal appendix are rare; 1/10,000 cases are reported worldwide and constitute 0.2 to 0.5% of all tumors of the digestive tract. Its difficult pre-surgical diagnosis is an obstacle to its timely treatment.
CASE PRESENTATION
Patient, 62 years old, male, with a history of Diabetes Mellitus type II, High Blood Pressure, Chronic Kidney Disease stage 5D secondary to kidney disease due to Diabetes, undergoing CAPD treatment. At the 4th month of dialysis treatment, the patient began to present with a clinical picture characterized by diffuse abdominal pain, nausea and fever. On physical examination: depressible abdomen, painful on deep palpation, air fluid sounds present. Rest of the physical examination normal. The results of the peritoneal effluent study were: Cell count greater than 100 leukocytes/mm3, more than 30% eosinophils, negative peritoneal effluent culture, leukogram with predominance of eosinophils (more than 500 per mm3).
A diagnosis of PE was made. Treatment was started with IP hydrocortisone, without antibiotics initially due to a negative culture. On the 3rd day of corticosteroid treatment, there was improvement in the cell count, but not in the symptoms, with the patient remaining algid and feverish. Paraclinical tests show leukocytosis and eosinophilia, hospitalization is decided, IP antibiotic treatment and a CT scan of the abdomen report an increase in the appendiceal diameter, so an evaluation is requested by Surgery that performs an appendectomy. Biopsy report indicates well-differentiated neuroendocrine tumor infiltrating periappendiceal adipose tissue.
PE is a non-infectious and rare peritonitis, although there are several reports, in patients undergoing PD. It develops shortly after the start of dialysis. The process is generally benign and self-limiting.
The peritoneal effluent is cloudy due to PMN leukocytes, of which 10 to 95% are eosinophils. Peritoneal fluid culture is always negative. Around 60% of patients with peritoneal eosinophilia also have it in the peripheral blood. Its pathogenesis is not well known; It is suggested that it is an immunological reaction due to hypersensitivity. Antibiotic therapy has not proven to be useful, it has been seen that the use of IP steroids is related to rapid clearance of the fluid.
PE is a non-infectious peritonitis, rare in PD patients. It is generally benign and has a good prognosis. There is no literature that relates it to neuroendocrine tumors of the digestive tract, but it does relate to neoplasms in general, which is why the histopathological study of the appendix is important, given that even intraoperatively this disease is not suspected, which leads to a late diagnosis. and worse prognosis.