NDT Advance Access originally published online on November 7, 2006
Nephrology Dialysis Transplantation 2007 22(3):975-976; doi:10.1093/ndt/gfl663
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Pancreatitis and pancreatic abscess in a CAPD patient with severe malnutrition
Email: mnishida{at}koto.kpu-m.ac.jpSir,
Previous reports have suggested protein-energy malnutrition as a cause for pancreatitis [1,2]. However, pancreatitis or pancreatic abscess associated with malnutrition in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) has not been reported. Furthermore, reports of pancreatic abscess complications in CAPD patients are rare [3]. We report here a CAPD patient who developed severe malnutrition due to depressive disorder, and further developed acute pancreatitis that resulted in widespread intra-abdominal pancreatic abscesses.
A 20-year-old woman was admitted to our hospital for the restoration of her nutritional status. She had been undergoing CAPD since she was 12 years of age, because of congenital bilateral hypoplastic kidney, and was suffering depressive status and concurrent severe malnutrition since the age of 15. She consulted a psychiatrist and was diagnosed with anorexia due to depressive disorder. On admission, her body weight had decreased to 21 kg with a body mass index of 11 kg/m2. Gavages of nutritional supplements were started. However, 2 weeks later, she abruptly developed acute pancreatitis. Despite conservative treatments, large pancreatic pseudocysts were noted on computed tomography (CT) 2 months later. Six months after the onset of pancreatitis, she became feverish with increased leucocyte counts in the dialysate. Methicillin-resistant Staphylococcus epidermidis was isolated from cultures of blood and intravenous catheter; however, culture of the dialysate was negative. CAPD was stopped and changed to haemodialysis. Ga scintigraphy and contrast-enhanced CT suggested the existence of widespread multiple intra-abdominal abscesses (Figure 1). Percutaneous drainages were performed, and elevated amylase levels in drained fluids indicated that these abscesses originated from infected pancreatic cysts. Staphylococcus species was isolated from a culture of the drained fluid. Despite several recurrences during the next 3 months, remissions of intra-abdominal abscesses were obtained thereafter. At present, 24 months after pancreatitis, she is still undergoing total parenteral nutrition and haemodialysis.
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Our patient had no common cause for pancreatitis, such as gallstone, alcohol, metabolic aetiologies, drugs or trauma. Previous reports, however, indicate that either chronic malnutrition, or refeeding after periods of malnutrition, may contribute to the occurrence of pancreatitis [1,2]. Previous reports have also shown that dialysis patients, especially patients receiving long-term peritoneal dialysis, have an increased risk for acute pancreatitis [4]. Nevertheless, malnutrition has not been recognized as an aetiological factor for pancreatitis in CAPD patients. Recently, a case of acute pancreatitis associated with malnutrition due to depressive disorder, as was observed in our case, was reported [2]. Depression is the most common psychological problem in dialysis patients, commonly associated with poor oral intake and aggravated malnutrition [5]. Thus, we should bear in mind that, in CAPD patients, pancreatitis may develop in association with malnutrition, possibly due to depressive disorder, and may cause serious complications such as pancreatic abscesses.
Conflict of interest statement. None declared.
Department of Pediatric Cardiology
and Nephrology
Kyoto Prefectural
University of Medicine Graduate School
of Medical Science
Kyoto, Japan
References
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[Abstract/Free Full Text] - Reddymasu S, Banks DE, Jordan PA. (2006) Acute pancreatitis in a patient with malnutrition due to major depressive disorder. Am J Med 119:179–180.[CrossRef][Web of Science][Medline]
- Hu J, Sheu MH, Yang WC, Li JC, Ng YY. (2002) Peritonitis and pancreatic abscess in a CAPD patient. Perit Dial Int 22:430–431.
[Free Full Text] - Quraishi ER, Goel S, Gupta M, Catanzaro A, Zasuwa G, Divine G. (2005) Acute pancreatitis in patients on chronic peritoneal dialysis: An increased risk? Am J Gastroenterol 100:2288–2293.[CrossRef][Web of Science][Medline]
- Einwohner R, Bernardini J, Fried L, Piraino B. (2004) The effect of depressive symptoms on survival in peritoneal dialysis patients. Perit Dial Int 24:256–263.
[Abstract/Free Full Text]
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