Hemoperitoneum detected by peritoneal dialysis as presenting symptom of cytomegalovirus-associated colitis: a case report

Immune checkpoint inhibitors and tyrosine kinase inhibitors have transformed cancer therapy also for patients with end-stage-kidney-disease. We here report hemoperitoneum and peritonitis in a peritoneal dialysis patient after therapies with both drug classes. The differential diagnosis included peritoneal dialysis associated peritonitis, immune checkpoint inhibitor -associated colitis, viral reactivation as well as an unrelated gastrointestinal process. Colonic resection revealed perforation, granulocytic and lymphocytic inflammation together with cytomegalovirus DNA. Symptoms responded to systemic Ganciclovir therapy. The case highlights the need for clinical vigilance and repeated diagnostics in the care of multimorbid individuals with unusual presentations and multidisciplinary state of the art therapies.