Bullous pemphigoid in patients receiving peritoneal dialysis: a case series and a literature survey

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

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Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid

Journal of Clinical Medicine ◽

10.3390/jcm10091916 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1916

Author(s):

Ágnes Kinyó ◽

Anita Hanyecz ◽

Zsuzsanna Lengyel ◽

Dalma Várszegi ◽

Péter Oláh ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Clinical Laboratory ◽

Case Series ◽

Dipeptidyl Peptidase ◽

Area Index ◽

Histological Features ◽

Dipeptidyl Peptidase 4 ◽

First Case ◽

Dipeptidyl Peptidase 4 Inhibitor ◽

The Mean

Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, p < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, p = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients.

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Uremic encephalopathy in patients undergoing assisted peritoneal dialysis: a case series and literature review

CEN Case Reports ◽

10.1007/s13730-019-00406-3 ◽

2019 ◽

Vol 8 (4) ◽

pp. 271-279 ◽

Cited By ~ 2

Author(s):

Akane Yanai ◽

Kiyotaka Uchiyama ◽

Yoshitaka Ishibashi

Keyword(s):

Peritoneal Dialysis ◽

Literature Review ◽

Case Series ◽

Uremic Encephalopathy ◽

Assisted Peritoneal Dialysis

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Is it time to revise linezolid doses in peritoneal dialysis patients? A case series

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkv184 ◽

2015 ◽

Vol 70 (10) ◽

pp. 2918-2920 ◽

Cited By ~ 6

Author(s):

Cristina Gervasoni ◽

Roberto Bergia ◽

Valeria Cozzi ◽

Emilio Clementi ◽

Dario Cattaneo

Keyword(s):

Peritoneal Dialysis ◽

Case Series ◽

Dialysis Patients

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785. Treatment of Mycobacterium immunogenum Skin and Soft-Tissue Infections: A Case in a Peritoneal Dialysis Patient

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.792 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S281-S281

Author(s):

Walid El-Nahal ◽

Abhishek Shenoy ◽

McCall Walker ◽

Tushar Chopra ◽

Greg Townsend ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Soft Tissue ◽

Case Series ◽

Peritoneal Dialysis Patient ◽

Empiric Therapy ◽

Human Infection ◽

Surgical Debridement ◽

Nontuberculous Mycobacterium ◽

Peritoneal Dialysis Catheter ◽

Soft Tissue Infections

Abstract Background Mycobacterium immunogenum is a somewhat recently identified species of rapidly growing nontuberculous mycobacteria, genetically related to M. abscessus and M. chelonae. Resistance patterns of rapidly growing nontuberculous mycobacterium species can make them difficult to treat. This is particularly true of M. immunogenum, in part due to the infrequency of reported cases of human infection and limited data to guide therapy. Methods We present here a case of M. immunogenum skin and soft-tissue infection at the site of insertion of a peritoneal dialysis catheter in a patient with end-stage renal disease. He initially presented with nodular subcutaneous lesions around his catheter site that progressed through oral antibiotics. This led to sampling which confirmed the diagnosis of M. immunogenum. We conducted a review of the literature to identify previously reported cases of M. immunogenum, including skin and soft-tissue infections, and used these data to guide management. Results We reviewed 11 reports (cases and case series) of Mycobacterium immunogenum in the literature. Susceptibilities often take weeks to return, and so empiric therapy is based on case series, and then later adjusted based on susceptibilities. Patients received combined antimicrobial regimens with durations of 2 weeks to 12 months, with variable outcomes. Several required surgical debridement, as was the case with our patient. His PD catheter was removed and he was treated empirically with amikacin, azithromycin, and tigecycline intravenous induction. His ultimate long-term regimen was later switched to azithromycin, clofazimine, and tedizolid due to side effects and the eventually available susceptibility profile. Conclusion The treatment of M. immunogenum remains a challenge due to the relative scarcity of data to guide treatment, and consequent lack of systemic approach to therapy. Most reported cases involve the use of a macrolide, often in combination with an aminoglycoside or a fluoroquinolone. Several started with intravenous induction, followed by transition to oral therapy on the order of weeks to months. Others also require surgical debridement. More data are required to develop a standardized approach to the treatment of M. immunogenum. Disclosures All authors: No reported disclosures.

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COVID-19 in Hospitalized Patients on Chronic Peritoneal Dialysis: A Case Series

American Journal of Nephrology ◽

10.1159/000510259 ◽

2020 ◽

Vol 51 (8) ◽

pp. 669-674 ◽

Cited By ~ 1

Author(s):

Mala Sachdeva ◽

Nupur N. Uppal ◽

Jamie S. Hirsch ◽

Jia H. Ng ◽

Deepa Malieckal ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Clinical Course ◽

Case Series ◽

The United States ◽

Hospitalized Patients ◽

End Stage Kidney Disease ◽

Entire Cohort ◽

End Stage ◽

Culture Negative ◽

Descriptive Statistical Analysis

Background: The COVID-19 pandemic has affected the end-stage kidney disease (ESKD) population, with high mortality rates reported among patients on hemodialysis. However, the degree to which it has affected the peritoneal dialysis (PD) population in the United States has not yet been elucidated. In this report, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19. Methods: We describe the characteristics, presentation, and outcomes of adult ESKD patients on chronic PD hospitalized with COVID-19 in our 13 major hospitals in the NY health system using descriptive statistical analysis. Results: Of 419 hospitalized patients with ESKD, 11 were on chronic PD therapy (2.6%). Among those 11, 3 patients required mechanical ventilation, 2 of whom died. Of the entire cohort, 9 of the 11 patients (82%) were discharged alive. While fever was a common presentation, more than half of our patients also presented with diarrhea. Interestingly, 3 patients were diagnosed with culture-negative peritonitis during their hospitalization. Seven patients reported positive SARS-CoV-2 exposure from a member of their household. Conclusion: Hospitalized patients on PD with COVID-19 had a relatively mild course, and majority of them were discharged home.

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Treatment of bullous pemphigoid with adjuvant immunoadsorption: A case series

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2014.06.014 ◽

2014 ◽

Vol 71 (5) ◽

pp. 1018-1020 ◽

Cited By ~ 17

Author(s):

Michael Kasperkiewicz ◽

Franziska Schulze ◽

Markus Meier ◽

Nina van Beek ◽

Martin Nitschke ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Case Series

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Cefotaxime and Metabolite Disposition in Two Pediatric Continuous Ambulatory Peritoneal Dialysis Patients

Annals of Pharmacotherapy ◽

10.1177/106002809202600307 ◽

1992 ◽

Vol 26 (3) ◽

pp. 341-343 ◽

Cited By ~ 9

Author(s):

Christopher M. Paap ◽

Milap C. Nahata ◽

Mark A. Mentser ◽

John D. Mahan ◽

Surendra K. Puri ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Half Life ◽

Pediatric Patients ◽

Intraperitoneal Administration ◽

Case Series ◽

Systemic Absorption ◽

Maximum Plasma ◽

Total Clearance ◽

Intraperitoneal Dose

OBJECTIVE: To characterize the pharmacokinetics of cefotaxime and desacetylcefotaxime in pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD) after intraperitoneal administration of cefotaxime. DESIGN: Case series. SETTING: Ambulatory children from Children's Hospital nephrology clinic, Columbus, Ohio. PATIENT POPULATION: Two adolescents without peritonitis. METHODS: A single intraperitoneal dose of cefotaxime 500 mg per 1 L dianeal was given during CAPD. Cefotaxime and desacetylcefotaxime were measured in plasma, urine, and dialysate by HPLC. RESULTS: Maximum plasma concentration (Cmax,) of cefotaxime was 11.94 and 13.08 mg/L and that of desacetylcefotaxime 5.73 and 5.33 mg/L. Time to reach maximum concentration (Tmax) of cefotaxime was 2.22 and 4.08 h, and that of desacetylcefotaxime was 5.33 and 5.73 h after instillation of the intraperitoneal cefotaxime dose. Systemic absorption of cefotaxime was 56.6 and 64.8 percent. Total clearance of cefotaxime was 62 and 79 mL/min/1.73 m2. Nonrenal clearance accounted for nearly 95 percent; renal and CAPD clearance contributed approximately 5 percent of the total clearance. Renal and CAPD clearance measurements of desacetylcefotaxime were similar to those for cefotaxime. Cefotaxime half-life was 1.83 and 2.49 h and desacetylcefotaxime half-life was 8.14 and 11.0 h. CONCLUSIONS: Cefotaxime was well absorbed and therapeutic serum concentrations were achieved after intraperitoneal administration. Renal and CAPD clearances for cefotaxime and desacetylcefotaxime were low. Cefotaxime nonrenal clearance was unaffected. Further studies are needed to establish appropriate intraperitoneal dosing guidelines of cefotaxime in pediatric CAPD patients.

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