ISPD-APC/ISN-OSEA PD Case Discussion

  • July 21, 2026
    Zoom Meeting

ISPD-APC/ISN-OSEA PD Case PROTOCOL

Case 1 — Adult: Eosinophilic Peritonitis Mimicking Relapsing Culture-Negative PD Peritonitis

A 25-year-old man with newly diagnosed ESKD secondary to hypertension transitioned from hemodialysis to maintenance peritoneal dialysis (February 2026). His prescription consisted of three daily exchanges of 1.5% glucose (1,500 mL, 4-hour dwells), with a residual urine output of approximately 500 mL/day. He had no previous medical or surgical history.

Two months after PD initiation, he presented with abdominal pain and cloudy dialysate. Initial peritoneal effluent analysis demonstrated 2,394 cells/µL, with 78% neutrophils, consistent with PD-associated peritonitis. Empiric intraperitoneal cefazolin and ceftazidime were initiated, but dialysate cultures remained negative after five days. Therapy was simplified to vancomycin after ceftazidime discontinuation, and the effluent cleared by day 7. A 2-week antibiotic course was planned.

However, on treatment day 10, the dialysate again became cloudy, this time without abdominal pain or systemic symptoms. Repeat effluent analysis revealed 340 cells/µL with marked eosinophilia (49%), while neutrophils accounted for only 6%.

Case 2 — Child: Acute Eosinophilic Peritonitis Following Hypertonic PD Solution Escalation

A 3-year-old girl with biopsy-proven minimal change disease causing steroid-resistant nephrotic syndrome had failed multiple immunosuppressive therapies because of recurrent infections and AKI. She presented with anasarca and anuria, requiring initiation of acute peritoneal dialysis (October 2025). PD was commenced using low-volume, short-cycle exchanges with 1.5% glucose solution and subsequently escalated to 2.3% glucose because of inadequate ultrafiltration.

Within 24 hours of increasing dialysate glucose concentration, she developed fever, abdominal pain, and cloudy effluent, raising concern for acute PD-associated peritonitis. Peritoneal effluent contained 464 cells/µL, prompting empiric intraperitoneal cefazolin and ceftazidime. Dialysate cultures remained sterile, while differential cell count demonstrated predominant eosinophilia (52%) with only 15% neutrophils.