A case of suspected peritoneal thermal injury complicated by septic shock following infusion of perceptibly hot peritoneal dialysate

Background Peritoneal dialysis-associated peritonitis mostly arises from fluid exchange contamination, catheter tunnel exit infection or intestinal flora translocation. Peritoneal thermal injury triggered by perceptibly hot peritoneal dialysate, which advances to secondary suppurative peritonitis and fatal septic shock, is extremely rare. Few published studies have documented complete clinical courses of this life-threatening complication. Such incidents are often overlooked in routine home peritoneal dialysis administration. Experimental evidence confirms dialysate temperatures exceeding 43 °C cause irreversible peritoneal barrier destruction, while the standard infusion temperature is 36–37 °C. Case presentation A 57-year-old male on long-term home peritoneal dialysis suffered severe acute abdominal pain immediately after infusing perceptibly hot peritoneal dialysate caused by temperature control failure of his heating device. He rapidly developed purulent turbid dialysate, markedly elevated inflammatory markers and refractory septic shock. Multidisciplinary comprehensive interventions including broad-spectrum antibiotics, haemodynamic stabilisation and CRRT could not reverse his critical condition. The patient died one day after his family elected to discontinue active treatment. We report the full clinical data of this case and systematically analyse its potential pathogenesis, disease progression, key differential diagnoses and full-course therapeutic strategies. Conclusions Heating equipment malfunction and inadequate standardised temperature management can lead to injury induced by perceptibly hot peritoneal dialysate, which initiates a sequential cascade of aseptic chemical inflammation and severe polymicrobial infection. Clinicians should strengthen standardised heating procedures and tiered patient education to prevent this rare yet highly fatal dialysis adverse event. This case delivers vital clinical alerts for temperature safety supervision in home peritoneal dialysis.