Vancomycin-induced eosinophilic peritonitis

Abstract

Purpose: A case of eosinophilic peritonitis (EP) with severe cardiovascular compromise in a patient receiving intraperitoneal vancomycin therapy is described.

Summary: A woman with a medical history including hypertension, end-stage renal disease, and anemia of chronic disease was hospitalized for complaints of severe abdominal pain and loss of appetite over the preceding four days; she had been undergoing peritoneal dialysis for about one year. Bacterial infection was diagnosed on the basis of peripheral blood and peritoneal fluid analyses showing highly elevated neutrophil and total nucleated cell (TNC) counts. Vancomycin was added to the peritoneal dialysis bags, with subsequent dramatic TNC and neutrophil reductions over two days, but the woman's condition continued to worsen; she developed severe hypotension and on hospital day 13 was transferred to the intensive care unit for central line placement and vasopressor support. The clinician team determined that conversion from bacterial peritonitis to EP had occurred. After the exclusion of other potential causes of EP (e.g., a reaction to dialysis equipment, antihypertensive medication use), intraperitoneal administration of vancomycin was deemed to be the probable cause. Within days of discontinuation of vancomycin use, the patient's hypotension abated, her abdominal symptoms resolved, and she was discharged home. In this case, the diagnosis of EP was complicated by the initial presentation of bacterial peritonitis (confirmed by laboratory and culture data). A literature search identified one other published report of vancomycin-induced EP.

Conclusion: A 37-year-old woman developed EP after receiving vancomycin intraperitoneally. The infection resolved after discontinuation of vancomycin.