Abstract
Background
Dialysate leakage into the pericardium is a rare but potentially life-threatening complication of peritoneal dialysis (PD). There has been one reported pediatric case of spontaneous peritoneo-pericardial fistula in a 2-year-old boy with tissue fragility due to malnutrition and two reported adult cases in PD patients with a history of previous cardiac surgery and/or pericardiocentesis.
Case-Diagnosis/Treatment
We describe a 15-year-old girl with end-stage renal disease secondary to granulomatosis with polyangiitis, with recurrent pericardial effusions secondary to a peritoneo-pericardial fistula while on continuous cycling peritoneal dialysis (CCPD). She had previously presented with chylous pericardial effusion that required pericardiocentesis and subsequently developed recurrent pericardial effusions when she was commenced on CCPD 9 months later. Pericardial fluid chemistry revealed a sterile, serous fluid containing 15.1 mmol/L of glucose and <0.11 mmol/L of triglycerides. Peritoneal scintigraphy with Tc-99m labeled sulfur colloid injected intra-peritoneally confirmed the presence of a peritoneo-pericardial fistula. The pericardial effusions resolved upon switching the patient to hemodialysis (HD).
Conclusions
Our case of recurrent pericardial effusions in a child on PD secondary to a peritoneo-pericardial fistula highlights the need for close follow-up in patients with a history of previous pericardiocentesis who are commenced on PD.
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References
Nomoto Y, Suga T, Nakajima K, Sakai H, Osawa G, Ota K, Kawaguchi Y, Sakai T, Sakai S, Shibata M (1989) Acute hydrothorax in continuous ambulatory peritoneal dialysis—a collaborative study of 161 centers. Am J Nephrol 9:363–367
Borzych D, Ley S, Schaefer F, Billing H, Ley-Zaporozhan J, Schenk J, Schmidt CP (2008) Dialysate leakage into pericardium in an infant on long-term peritoneal dialysis. Pediatr Nephrol 23:335–338
Nather S, Anger H, Koall W, Reis A, Mukhtar B, Grimm C, Drescher J, Osten B (1996) Peritoneal leak and chronic pericardial effusion in a CAPD patient. Nephrol Dial Transplant 11:1155–1158
Hou CH, Tsai TJ, Hsu KL (1994) Peritoneopericardial communication after pericardiocentesis in a patient on continuous ambulatory peritoneal dialysis with dialysis pericarditis. Nephron 68:125–127
Dufek S, Holtta T, Fischbach M, Ariceta G, Jankauskiene A, Cerkauskiene R, Schmitt CP, Schaefer B, Aufricht C, Wright E, Stefanidis CJ, Ekim M, Bakkaloglu S, Klaus G, Zurowska A, Vondrak K, Vande Walle J, Edefonti A, Shroff R, European Paediatric Dialysis Working Group (2015) Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis—a survey from the European Paediatric Dialysis Working Group. Pediatr Nephrol. doi:10.1007/s00467-015-3137-z
Larkins N, Harris KC, Morishita K, Matsell DG (2014) Chylous pericardial effusion in granulomatosis with polyangiitis. Nephrology (Carlton) 19:367–368
Rottem M, Fauci AS, Hallahan CW, Kerr GS, Lebovics R, Leavitt RY, Hoffman GS (1993) Wegener granulomatosis in children and adolescents: clinical presentation and outcome. J Pediatr 122:26–31
Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS (1992) Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 116:488–498
Forstot JZ, Overlie PA, Neufeld GK, Harmon CE, Forstot SL (1980) Cardiac complications of Wegener granulomatosis: a case report of complete heart block and review of the literature. Semin Arthritis Rheum 10:148–154
Litherland J, Lupton EW, Ackrill PA, Venning M, Sambrook P (1994) Computed tomographic peritoneography: CT manifestations in the investigation of leaks and abnormal collections in patients on CAPD. Nephrol Dial Transplant 9:1449–1452
Prischl FC, Muhr T, Seiringer EM, Funk S, Kronabethleitner G, Wallner M, Artmann W, Kramar R (2002) Magnetic resonance imaging of the peritoneal cavity among peritoneal dialysis patients, using the dialysate as “contrast medium”. J Am Soc Nephrol 13:197–203
Juergensen PH, Rizvi H, Caride VJ, Kliger AS, Finkelstein FO (1999) Value of scintigraphy in chronic peritoneal dialysis patients. Kidney Int 55:1111–1119
Macia M, Gallego E, Garcia-Cobaleda I, Chahin J, Garcia J (1995) Methylene blue as a cause of chemical peritonitis in a patient on peritoneal dialysis. Clin Nephrol 43:136–137
Chavannes M, Sharma A, Singh R, Reid R, Filler G (2014) Diagnosis by peritoneal scintigraphy of peritoneal dialysis-associated hydrothorax in an infant. Perit Dial Int 34:140–143
Tang S, Chui WH, Tang AW, Li FK, Chau WS, Ho YW, Chan TM, Lai KN (2003) Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. Nephrol Dial Transplant 18:804–808
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Teoh, C.W., Nadel, H., Armstrong, K. et al. Peritoneal–pericardial communication in an adolescent on peritoneal dialysis. Pediatr Nephrol 31, 153–156 (2016). https://doi.org/10.1007/s00467-015-3206-3
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DOI: https://doi.org/10.1007/s00467-015-3206-3