Abstract: FR-PO1113
Encapsulating Peritoneal Sclerosis Related to SARS-CoV-2 Infection
Session Information
- COVID-19 - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Rodríguez García, Enrique Iván, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
- Ovando-Morga, Daniel Fernando, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
- de la Cruz Jasso, Mercedes Andrea, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
- Rivas Bucio, Ruth Ixel, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
- Salazar, Juan J., Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
Introduction
Encapsulating peritoneal sclerosis (EPS) is an extremely rare complication of long-term PD, associated with high morbidity and mortality (50%). The reported incidence is 0.7 and 13.6 per 1,000 pts-year.
PD duration is the key risk factor, higher dialysate glucose exposure, peritonitis rate, younger age, abdominal surgery, icodextrin (ICO), UF failure, and higher peritoneal solute transport rate as well.
Diagnosis is based upon a combination CT findings and intermittent subacute bowel obstruction. Only a fibrous cocoon wrapped around the bowel is diagnostic.
Case Description
41-year-old female, history of diabetes and hypertension. CKD of unknown etiology since 2020, she began APD since 1 yr, 2.5% PD solution + ICO. 3 episodes of peritonitis in 2021. History of umbilical hernia repair and 2 cesareans.
9 days before admission with a + Covid-19 test, 3 days before she had abdominal pain and clinical data of intestinal oclussion (IO). She was admited with BP 60/40 mmHg, IV resuscitated and treated w/MTZ and CRO. PD count (PDC) showed 1,842 leu, concluding IO and peritonitis. An exploratory laparotomy (EL)was performed with removal and replacement of catheter. After 5 days a PDC showed refractory peritonitis, transferred to HD and antibiotics were escalated (VCM and CTZ). 7 days after EL, PD catheter was removed. She persisted with IO, a CT scan corroborate it; A new EL was done with finding of fibrous cocoon wrapped around the bowel and peritoneal biopsy with fibrosis and chronic inflammation.
Discussion
The patient has risk factors for EPS: PD with ICO, and 2.5% PD solutions, however the main reported risk factor is time in PD, in her case it was considered low.
Covid-19 infection has been associated with a possible effect of the virus on the peritoneal mesothelial cells (MCs). Although there is no in vivo direct evidence so far of MCs infection by the virus, despite this, MCs have been found to express SARS-CoV-2 specific receptors/co-receptors ACE2. In this case we consider a strong association between Covid-19 and EPS. To our knowledge there are not previous reported cases and this represents and area for future research.