Case 464 -- A 36 Year-old Man with Abdominal Pain

Contributed by James T Edinger, MD and A William Pasculle, ScD
Published on line in May 2006


The patient is a 36 year-old African American male with a history of end stage renal disease secondary to IgA nephropathy. He underwent kidney transplantation in 2001, which subsequently failed in 2005 due to rejection. Allograft nephrectomy was performed in 2006 because of hematuria. He had been on peritoneal dialysis prior to his transplantation and wished to resume this method of renal replacement after the failure of his transplant. A dialysis catheter was placed in November 2005. Three months later, he presented with abdominal pain and cloudy peritoneal drainage. On physical exam, he was afebrile with normal vital signs. He had peri-umbilical tenderness with guarding and rebound tenderness. Peripheral white blood cell count was 10,600/cu mm with a normal differential. CT scan of the abdomen showed no free or loculated fluid collections. A sample of peritoneal fluid was sent for culture (Figs. 1, 2 and 3)



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