Robert Wens

Campylobacter fetus peritonitis followed by septicaemia in a patient on continuous ambulatory peritoneal dialysis

A 62-year-old man being treated by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis due to Campylobacter fetus subspecies fetus (intestinalis), an organism seldom isolated in such circumstances. After appropriate and apparently effective antibiotic therapy, the patient relapsed 6 weeks later with septicaemia. Blood cultures yielded a similar organism, thereby suggesting a clinically silent metastatic infection during the episode of peritonitis, probably at an old arteriovenous fistula. Parenteral tobramycin followed by oral erythromycin achieved a complete cure of this unusual complication.

Treatment of thrombotic thrombocytopenic purpura.

TTP treated with Rituximab after initial PE. A 59-year-old man was hospitalised for aphasia, paresis of the inferior right facial nerve, and fever (38 °C). His blood analysis revealed low platelets (15,000/mm3), haemolytic microangiopathic anaemia (hemoglobin=10.2 g/dl, schistocytes 8%, LDH 1,300 UI/l, haptoglobin 0.05 g/l), and renal failure (creatinine=123.9 mmol/l, urea=18.5 mmol/l). PE with 60 ml/kg fresh frozen plasma daily and methylprednisolon (1 mg·kg·day) was started. Although neurological symptoms and thrombopenia resolved after four PE, two PE/week were needed in order to achieve a platelet count of >100,000/mm3. Methylprednisolon was tapered off after 2 weeks. ADAMTS13 activity (AA) was undetectable and inhibitor activity (IA) was 16 BU/ml before the first PE. During PE AA was <5% and IA was oscillating between 2 BU/ml and 8 BU/ml. After Rituximab was administered at 375 mg·m2·week during 4 weeks, the platelet count stabilized at >150,000/mm3, PE was discontinued, AA was 7.5%, and IA became undetectable. The patient has been in remission for 9 months. In conclusion, although only anecdotal reports are available, Rituximab is very promising in the treatment of TTP with deficiency of AA and IA. Prospective studies, however, are difficult to perform due to the rareness of TTP.

Peritoneal ultrafiltration (UF) with extraneal for overhydration due to congestive heart failure (CHF) and nephrotic syndrome

Congestive heart failure unresponsive to maximal drug treatment has been known to benefit from UF. We wish to report our experience with peritoneal UF using Extraneal. Eight patients with severe CHF (NYHA stages III in 3 and IV in 5 with ejection fractions under 30% in all), and one with diabetic nephrotic syndrome, unresponsive to dietary and drug treatments (ACE-I, diuretics, digitalis, vasodilators) were offered to try Extraneal therapy after informed consent. Three of them had normal renal function while six had various degrees of renal impairment (creatinine clearances ranging from 25 to 60 ml/min.). The causes of CHF were diabetic and ischemic cardiomyopathies in 1 and 7 patients, respectively. Depending on the level of renal function (