Abstract: FR-PO463
Novel Use of Intraperitoneal Acyclovir for Herpes Simplex Virus 2-Related Viral Peritonitis: A Case Report
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Dhoot, Arti, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Tanna, Gemini, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Auguste, Bourne L., Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Introduction
Viral etiologies for peritonitis can be misclassified as culture negative peritonitis due to poor accessibility of viral testing in the effluent fluid. Inaccurate diagnosis and subsequent ineffective treatment can lead to unnecessary catheter removal for presumed refractory peritonitis. We present the only reported case of herpes simplex virus-2 (HSV-2) related PD peritonitis that was successfully treated with intraperitoneal (IP) acyclovir.
Case Description
A 73-year old female on continuous cyclic peritoneal dialysis with a past medical history relevant for HSV-2 genital lesions presented with a cloudy effluent, elevated effluent WBC count with lymphocytic predominance and a recent HSV-2 flare. Initially thought to be culture negative peritonitis but no reduction was seen in cell count on empiric IP cefazolin and ceftazidime. Effluent was sent for viral culture on day 8 and discovered to be positive for HSV-2 via PCR on day 12. Oral acyclovir was used initially but then converted to intraperitoneal route to minimize adverse events. IP acyclovir was reconstituted in a 2.5% Dianeal bag and administered for 14 days based on pharmacokinetic data to achieve serum levels similar to intravenous administration. Patient’s cell counts improved and repeat effluent testing was negative for HSV-2 on day 27. Patient had no symptoms of neurotoxicity.
Discussion
Culture negative peritonitis can account for up to 20% of peritonitis cases however the effluent is largely just tested for bacterial and fungal presence. Clinicians should be aware to the possibility of viral peritonitis in patients with refractory culture negative peritonitis, especially if risk factors such as a history of HSV infection are present. Early recognition and timely initiation of antivirals may prevent inadvertent catheter removal for presumed refractory peritonitis and help retain patients on PD. Most importantly, utilizing IP route of administration for acyclovir may lead to lower drug related toxicity whilst achieving therapeutic serum concentrations and allow for ongoing outpatient management of home dialysis patients on PD.