Successful Treatment of Encapsulating Peritoneal Sclerosis by Hemodialysis and Peritoneal Lavage Using Dialysate Containing Dissolved Hydrogen

REPORTSdue to Kingella species, nothing has been mentioned about using intraperitoneal antibiotics with PD fluid.Although our patient attempted to maintain strict sterile precautions and took appropriate care of her PD catheter site, 1 possibility may be that she contaminated the PD set with her oral secretions while coughing.She did admit that maybe 1 -2 times she failed to use a facemask.This is a hypothesis only, as there is no definitive evidence of causality in our case.There is also no evidence in our case of the organism traversing the gastrointestinal tract to gain entrance into the peritoneal cavity.The possibility of causation via blood borne entry from the oral cavity or aerosol contamination seems to be the most plausible.Figueiredo et al. (18) suggested that use of a face mask during CAPD bag exchange gives no extra protection against peritoneal contamination.More importantly, patients must be educated to perform the connect/disconnect operation carefully, and to strictly observe accidental contamination of the hands.But the description was limited to a single renal unit with a seemingly small number of patients.Also, the patients were healthy and not sick like our patient who was coughing intermittently.This stresses the importance of strict hand hygiene and using a mask, especially if sick, before doing PD exchanges.She will be continued on long-term antibiotics for 6 weeks, her PD catheter was removed, and she will undergo intermittent hemodialysis with a tunneled catheter.In retrospect, she may have had a better outcome with intraperitoneal antibiotics.After completing her 42 days of antibiotics and close follow-up with regard to the clinical response, she will be re-evaluated regarding timing for the placement of a new PD catheter.