ASD patient undergoing peritoneal dialysis may have recurrent peritonitis relapse

Recent case report from Jianying Wang and team showed that when a patient with atrial septal defect (ASD) undergoing peritoneal dialysis (PD) develops peritonitis, particularly relapse peritonitis, the risk of infective endocarditis (IE) increases considerably. ASD repair surgery may have a crucial role in preventing peritonitis recurrence. The findings of this study were published in BMC Nephrology.

Peritonitis is the most prevalent complication among peritoneal dialysis patients. Most patients recover after receiving adequate antibiotic therapy; however, when peritonitis recurs often, the cause of recurrence must be investigated. It is uncommon to find a link between an atrial septal defect, infective endocarditis, and peritonitis. Researchers describe a case of recurrent peritonitis caused by Staphylococcus aureus in a PD patient with ASD and IE.

Within 80 days of commencing PD, a 46-year-old woman with chronic renal failure due to chronic glomerulonephritis developed three bouts of peritonitis. The patient had an undiagnosed history of ASD with no symptoms. The patient was admitted to our hospital on April 5, 2016, after suffering PD for about 35 days, because of stomach discomfort and fever for 1 week (highest temperature of 38.5 °C), accompanied by chills and shaking. S. aureus was found in her PD effluent from the moment she was admitted.

Following that, peritonitis returned every month. Transthoracic echocardiography was used to diagnose the third episode of peritonitis. A vegetation measuring 9.5 6.4 mm was seen surrounding the ventricular septal membrane on the right ventricle's surface. The patient was subsequently identified as having IE. After the infection was under control, effective ASD repair surgery was then carried out. The patient was monitored for 5 years, and there were no more recurrence events.

In conclusion, D seldom results in IE, and IE linked to ASD is likewise quite uncommon. However, the risk of IE is greatly raised when a patient with ASD receiving PD develops peritonitis, particularly relapse peritonitis. Once an abdominal infection has started, an effective course of antibiotic therapy is required. ASD repair surgery may also have a significant role in avoiding the recurrence of peritonitis.

Reference:

Wang, J., Wu, S., & Sun, J. (2022). Recurrent peritonitis relapse in a patient with atrial septal defect undergoing peritoneal dialysis: a case report. In BMC Nephrology (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-022-03037-6