Encapsulating peritoenal sclerosis: Case report

Introduction. Encapsulating peritoneal sclerosis is a possible, serious, life-threatening complication of peritoneal dialysis therapy. Case 1. A female patient was hospitalized for clinical signs of encapsulating peritoneal sclerosis in the inflammatory stage with fever, intestinal occlusion, positive inflammatory syndrome (Le 20 K/μL, CRP 217 mg/L) and highly turbid peritoneal effluent (Le 3.3 K/μL) with sterile culture. Risk factors for the development of encapsulating peritoneal sclerosis were nine previous episodes of peritonitis and long-term use of high osmolality dialysis solution. The diagnosis was confirmed by computed tomography findings. During the course of therapy, the patient had a good response to Tamoxifen and prednisone. Although encapsulating peritoneal sclerosis was well controlled, the patient died after eight months due to tuberculosis of the lungs with signs of heart failure. Case 2. The clinical presentation also corresponded to encapsulating peritoneal sclerosis in the inflammation stage, and the identified risk factors were the long-term treatment with peritoneal dialysis (100 months) and an episode of peritonitis with tunnel infection. The first sign of encapsulating peritoneal sclerosis was hemorrhagic ascites, which was observed when the peritoneal catheter was being replaced. The diagnosis was confirmed by computed tomography findings. He was treated with Tamoxifen (10 mg 2x2 tbl). Except anemia, poor appetite and fatigue, the patient denied any other symptoms after 14 months of therapy. Conclusion. During peritoneal dialysis, one should always think about encapsulating peritoneal sclerosis which is not always easy to recognize. Timely diagnosis with the use of corticosteroids and Tamoxifen in the first and Tamoxifen in the second case were effective in controlling and preventing disease progression.