Spontaneous Bacterial Peritonitis in an Adult Patient with Minimal Change Disease
| Autor: | Hong Ik Kim, Dong Jik Ahn, Min-Kyung Kim, In Hee Lee |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Nephrotic Syndrome Peritonitis Gastroenterology Spontaneous bacterial peritonitis Internal medicine Ascites medicine Escherichia coli Ascitic Fluid Humans Minimal change disease Leukocytosis Hypoalbuminemia Child business.industry Nephrosis Lipoid General Medicine Articles Bacterial Infections Middle Aged medicine.disease Prednisolone medicine.symptom business Nephrotic syndrome medicine.drug |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| Popis: | Patient: Male, 60-year-old Final Diagnosis: Peritonitis Symptoms: Abdominal pain • edema of lower extermities Medication: — Clinical Procedure: — Specialty: Nephrology Objective: Rare disease Background: Pediatric patients with nephrotic syndrome have a high risk of developing spontaneous bacterial peritonitis (SBP). However, SBP in adults with nephrotic syndrome is very rare. We report a case of SBP induced by Escherichia coli in a 60-year-old male patient on immunosuppressive therapy for the treatment of minimal change disease (MCD). Case Report: The patient was hospitalized with abdominal pain and generalized edema that had lasted for 2 weeks. The patient first started treatment with high-dose oral prednisolone after being diagnosed with MCD 6 months ago. Complete remission of nephrotic syndrome was not achieved even after 5 months of treatment. Thus, the treatment was changed to combination therapy with cyclosporine and low-dose prednisolone. At the time of admission, leukocytosis, hypoalbuminemia, decreased serum immunoglobulin G (IgG), azotemia, and nephrotic-range proteinuria were observed. Ascitic fluid analysis showed a leukocyte count of 4960/μL (neutrophils 90%). On the suspicion of SBP associated with MCD, intravenous administration of empirical cefotaxime and supportive therapy were initiated; however, symptoms of peritonitis persisted. Extended-spectrum beta-lactamase-negative E. coli was found in ascites cultures. Laparoscopy-assisted peritoneal biopsy revealed no evidence of fungal infection; however, chronic inflammation without granuloma formation was noted. Afterward, cefotaxime was changed to piperacillin-tazobactam. After 4 weeks of antibacterial therapy, the peritonitis was cured and renal function was improved. Conclusions: Adult patients with steroid-resistant MCD accompanied by refractory ascites, severe hypoalbuminemia, and marked reduction in serum IgG are at a high risk of subsequent SBP and require careful monitoring. |
| Databáze: | OpenAIRE |
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