Resolution of severe eosinophilic peritonitis in a patient on continuous ambulatory peritoneal dialysis by changing from Dianeal peritoneal dialysis solution to Stay-Safe Balance solution: a case report

BACKGROUND: Eosinophilic peritonitis is a well-known complication at the initiation of peritoneal dialysis. It is often due to an allergic reaction to peritoneal dialysis solution or sometimes to the peritoneal dialysis catheter itself. Most cases are self-limiting with expected spontaneous resolution within a few weeks. Treatment is necessary for severe or persistent cases. However, the optimal treatment has not yet been defined. There have been only a few case reports on the use of anti-histamines and/or steroids for the treatment of eosinophilic peritonitis. We reported a case of severe eosinophilic peritonitis successfully treated by switching the brand of peritoneal dialysis fluid (same glucose concentration). To the best of our knowledge, this is the first reported case employing such a treatment strategy. CASE PRESENTATION: An eighty-two-year-old man with end-stage renal failure was started on continuous ambulatory peritoneal dialysis with Dianeal® (Baxter) peritoneal dialysis solution. He developed eosinophilic peritonitis 19 days after initiation of peritoneal dialysis. Infectious causes were ruled out by bacterial, fungal and tuberculosis smears and cultures. In view of the persistent and severe symptoms, we intervened by switching from Dianeal® (Baxter) peritoneal dialysis solution to Stay-Safe Balance® (Fresenius) solution with the same glucose concentration. His eosinophilic peritonitis resolved 5 days after switching the peritoneal dialysis solution. CONCLUSION: In severe or persistent cases of eosinophilic peritonitis requiring treatment, other than the use of steroids and anti-histamines, switching to a different brand of peritoneal dialysis solution can be considered.