Child Kidney Dis.  2023 Jun;27(1):46-53. 10.3339/ckd.23.008.

Pleuroperitoneal communication-associated pleuritis as an uncommon cause of fever of unknown origin in a child on peritoneal dialysis: a case report

• Park J
• Yoon H
• Jung J
• Lee J
• Lee JH

• KMID: 2544237
• DOI: http://doi.org/10.3339/ckd.23.008

Abstract

Pleuroperitoneal communication (PPC) is a rare mechanical complication of peritoneal dialysis (PD), which causes dialysate to move from the peritoneal cavity to the pleural cavity, resulting in pleural effusion. Typically, PPC is discovered through pleural effusion in PD patients who are not in volume overload status. A unique characteristic of the pleural effusion caused by PPC is that it is not resolved by increasing ultrafiltration by dialysis. In this report, we present a 7-year-old girl with PD after birth with the history of various infectious PD-related complications, presenting with fever ongoing for 6 months. PPC-associated pleuritis was suspected as the cause of fever, which eventually developed after long-term PD and induced complicated pleural effusion, lung inflammation, and prolonged fever for 6 months.

Keyword

Case reports; Child; Fever; Peritoneal dialysis; Pleural effusion

Figure

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  Fig. 1. Chest radiologic findings of a 7-year-old girl on peritoneal dialysis since birth, presenting with prolonged fever. Chest X-ray (A) and computed tomography (B) revealed multifocal peribronchial infiltration and complicated bilateral pleural effusion with diffuse enhancing pleural thickening in both lower lungs. Waxing and waning fever subsided, and pleural effusion decreased (C) after the cessation of peritoneal dialysis 6 months later.

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  Fig. 2. 18F-fludeoxyglucose whole body positron emission tomography-computed tomography (PET-CT) of a 7-year-old girl on peritoneal dialysis since birth. Whole body PET-CT (A) coronal and (B) right lateral views, demonstrated mild hypermetabolic uptake of subpleural consolidation and ground glass opacity lesions in both lungs and bilateral pleural effusions, ascites, and lymph nodes in the right lower paratracheal, subcarinal, pulmonary hilar, and left inguinal areas (injection site: right forearm).

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  Fig. 3. The clinical courses, laboratory findings, and treatment of a 7-year-old girl on PD with prolonged fever. (A) First admission (Dec 31, 2021–Feb 20, 2022). (B) Second admission (Feb 28, 2022–Mar 22, 2022). (C) Third admission (May 1, 2022–Jun 25, 2022). CRP, C-reactive protein; BT, body temperature; CT, computed tomography; APCT, abdominal and pelvic CT; EGD, esophagogastroduodenoscopy; PET-CT, positron emission tomography-CT, SAM, ampicillin-sulbactam; TZP, piperacillin-tazobactam; VAN, vancomycin; MEM, meropenem; IP IPM, intraperitoneal imipenem; HD, hospital day; FUO, fever of unknown origin; Ig, immunoglobulin; ANA, antinuclear antibody; C3, complement component 3; C4, complement component 4; CH50, complement component CH50; MRI, magnetic resonance imaging; PO, per oral; PD, peritoneal dialysis; AZA, azathioprine. a)Bladder augmentation and left nephroureterectomy operation for preparing the future kidney transplantation (May 2, 2022).

Reference

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