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Intestinal Strongyloides causing peritoneal eosinophilia in peritoneal dialysis.

Saha S, Sengsayadeth S, Golper TA - Clin Kidney J (2012)

Bottom Line: He was treated empirically for bacterial peritonitis and discharged although his PD fluid did not isolate any pathogens.He soon developed a partial small bowel obstruction and his serum Strongyloides IgG was positive.After treatment with ivermectin, stool microscopic examination showed Strongyloides stercoralis larvae.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine/Nephrology , Vanderbilt University Medical Center , Nashville, TN , USA.

ABSTRACT
A 59-year-old Laotian male with a past medical history of multiple myeloma on peritoneal dialysis (PD) presented with abdominal pain and peritoneal eosinophilia. He was treated empirically for bacterial peritonitis and discharged although his PD fluid did not isolate any pathogens. He soon developed a partial small bowel obstruction and his serum Strongyloides IgG was positive. After treatment with ivermectin, stool microscopic examination showed Strongyloides stercoralis larvae. This case illustrates that the differential diagnosis of peritoneal eosinophilia should include typical and atypical infections in addition to an allergic or hypersensitivity type reaction.

No MeSH data available.


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Strongyloides stercoralis larvae in dialysate. Reprinted with permission [7].
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SFS134F1: Strongyloides stercoralis larvae in dialysate. Reprinted with permission [7].

Mentions: The idiopathic variant of peritoneal eosinophilia has similarities to an allergy. Typical microbial infections complicating PD on occasion are accompanied by an unusual presence of peritoneal eosinophils. Microbial peritonitis associated with peritoneal eosinophilia may also be secondary to atypical infections like tuberculosis [4, 5]. A third category of peritoneal eosinophilia is that of infections caused by microbial agents or parasites that are known to provoke an eosinophilic reaction. Our institution reported a patient with a rejected renal transplant who developed E. coli PD-associated peritonitis [6]. She relapsed following initial improvement with antibiotics. Strongyloides stercoralis larvae were detected in the dialysate. In another report, larvae were seen in the peritoneal dialysate sediment (Figure 1) [7]. The considered mechanisms of Strongyloides infiltration were transmural migration or touch contamination. In our case, larvae were not detected in the dialysate nor was there any culture evidence that larvae tracked bacteria into the dialysate. Was peritoneal eosinophilia a reaction to the underlying bowel pathology, simply eosinophilic ascites related to Strongyloides infection, incidental to PD? Eosinophilic ascites in the absence of peritonitis was described with Toxocara canis infection in a patient not on dialysis, where the ascites may have resulted from larval invasion of the peritoneal cavity after excysting in the small bowel creating a local reaction [8]. Eosinophilic ileitis in a patient not on dialysis was also associated with peritoneal eosinophilia [9]. Strongyloides larvae burrow into duodenal and proximal jejunal mucosa; some mature and subsequently invade the bowel wall. This insult may cause an acute neighborhood reaction resulting in peritoneal eosinophilia.Fig. 1.


Intestinal Strongyloides causing peritoneal eosinophilia in peritoneal dialysis.

Saha S, Sengsayadeth S, Golper TA - Clin Kidney J (2012)

Strongyloides stercoralis larvae in dialysate. Reprinted with permission [7].
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400557&req=5

SFS134F1: Strongyloides stercoralis larvae in dialysate. Reprinted with permission [7].
Mentions: The idiopathic variant of peritoneal eosinophilia has similarities to an allergy. Typical microbial infections complicating PD on occasion are accompanied by an unusual presence of peritoneal eosinophils. Microbial peritonitis associated with peritoneal eosinophilia may also be secondary to atypical infections like tuberculosis [4, 5]. A third category of peritoneal eosinophilia is that of infections caused by microbial agents or parasites that are known to provoke an eosinophilic reaction. Our institution reported a patient with a rejected renal transplant who developed E. coli PD-associated peritonitis [6]. She relapsed following initial improvement with antibiotics. Strongyloides stercoralis larvae were detected in the dialysate. In another report, larvae were seen in the peritoneal dialysate sediment (Figure 1) [7]. The considered mechanisms of Strongyloides infiltration were transmural migration or touch contamination. In our case, larvae were not detected in the dialysate nor was there any culture evidence that larvae tracked bacteria into the dialysate. Was peritoneal eosinophilia a reaction to the underlying bowel pathology, simply eosinophilic ascites related to Strongyloides infection, incidental to PD? Eosinophilic ascites in the absence of peritonitis was described with Toxocara canis infection in a patient not on dialysis, where the ascites may have resulted from larval invasion of the peritoneal cavity after excysting in the small bowel creating a local reaction [8]. Eosinophilic ileitis in a patient not on dialysis was also associated with peritoneal eosinophilia [9]. Strongyloides larvae burrow into duodenal and proximal jejunal mucosa; some mature and subsequently invade the bowel wall. This insult may cause an acute neighborhood reaction resulting in peritoneal eosinophilia.Fig. 1.

Bottom Line: He was treated empirically for bacterial peritonitis and discharged although his PD fluid did not isolate any pathogens.He soon developed a partial small bowel obstruction and his serum Strongyloides IgG was positive.After treatment with ivermectin, stool microscopic examination showed Strongyloides stercoralis larvae.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine/Nephrology , Vanderbilt University Medical Center , Nashville, TN , USA.

ABSTRACT
A 59-year-old Laotian male with a past medical history of multiple myeloma on peritoneal dialysis (PD) presented with abdominal pain and peritoneal eosinophilia. He was treated empirically for bacterial peritonitis and discharged although his PD fluid did not isolate any pathogens. He soon developed a partial small bowel obstruction and his serum Strongyloides IgG was positive. After treatment with ivermectin, stool microscopic examination showed Strongyloides stercoralis larvae. This case illustrates that the differential diagnosis of peritoneal eosinophilia should include typical and atypical infections in addition to an allergic or hypersensitivity type reaction.

No MeSH data available.


Related in: MedlinePlus