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Lesesve J, Gérard D, Burgevin A. Uncommon but valuable for diagnosis: Green deposits on peritoneal fluid cytospins. Clin Case Rep 2021; 9:1553-1555. [PMID: 33768887 PMCID: PMC7981688 DOI: 10.1002/ccr3.3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022] Open
Abstract
When ascites fluids are observed under the microscope, unshaped greenish deposits should not be considered as artifacts but should rather prompt to bile leakage assessment.
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Affiliation(s)
| | - Delphine Gérard
- Laboratory of HematologyUniversity Hospital at NancyVandoeuvreFrance
| | - Alice Burgevin
- Department of Gastrointestinal SurgeryUniversity Hospital at NancyVandoeuvreFrance
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Masaki C, Matsushita K, Inoue T, Shima H, Chikakiyo M, Yamada M, Shirono R, Tashiro M, Tada H, Takamatsu N, Wariishi S, Okada K, Minakuchi J. Splenic abscess diagnosed following relapsing sterile peritonitis in a peritoneal dialysis patient: A case report with literature review. Semin Dial 2021; 34:245-251. [PMID: 33609413 DOI: 10.1111/sdi.12953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/31/2020] [Indexed: 11/30/2022]
Abstract
Peritoneal dialysis (PD)-related peritonitis is sometimes complicated with other infections; however, few cases of splenic abscess have been reported. We present the case of a 64-year-old PD patient with complicated splenic abscesses diagnosed following relapsing sterile peritonitis. After PD induction, he presented with turbid peritoneal fluid and was diagnosed with PD-related peritonitis. A plain abdominal computed tomography (CT) did not reveal any intra-abdominal focus of infection. After empiric intravenous antibiotics, the peritoneal dialysate was initially cleared, with a decrease in dialysate white blood cells (WBC) to 20/µL. However, WBC and C-reactive protein (CRP) levels remained elevated. A contrast-enhanced abdominal CT showed two areas of low-density fluid with no enhancement in a mildly enlarged spleen, making it difficult to distinguish abscesses from cysts. Due to relapsing sterile peritonitis, we performed an abdominal ultrasonography, and suspected splenic abscesses due to rapid increase in size. Repeated imaging tests were useful in establishing a diagnosis of splenic abscesses. Considering the persistent elevation of WBC and CRP levels, imaging findings, and episodes of relapsing peritonitis, we comprehensively formed the diagnosis, and performed a splenectomy as a rescue therapy. We should consider the possibility of other infectious foci with persistent inflammation after resolving PD-related peritonitis.
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Affiliation(s)
- Chiaki Masaki
- Department of Laboratory, Kawashima Hospital, Tokushima, Japan
| | - Kenta Matsushita
- Department of Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Tomoko Inoue
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Hisato Shima
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Motoya Chikakiyo
- Department of Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Mayumi Yamada
- Department of Laboratory, Kawashima Hospital, Tokushima, Japan
| | - Ryozo Shirono
- Department of Radiology, Kawashima Hospital, Tokushima, Japan
| | - Manabu Tashiro
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Hiroaki Tada
- Department of Laboratory, Kawashima Hospital, Tokushima, Japan
| | | | - Seiichiro Wariishi
- Department of Cardiovascular Surgery, Kawashima Hospital, Tokushima, Japan
| | - Kazuyoshi Okada
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Jun Minakuchi
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
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