Abstract
Recombinant granulocyte-colony stimulating factor (rhG-CSF) was administrered to a patient with granulocytopenia which developed during treatment for CAPD (continuous ambulatory peritoneal dialysis) peritonitis and good results were obtained. The patient was a 42-year-old female, who complained of abdominal pain, fever, and cloudy dialysate. She was emergently hospitalized with a diagnosis of peritonitis. Transient improvement was achieved by administration of vancomycin and heparin in the CAPD bag and intravenous administration of PIPC. However, the dosage of the intravenous antibacterial agent had to be increased because of a recurrence of inflammatory findings.
Thereafter, the WBC fell to 870/mm3. We suspected that bone marrow suppression, secondary to the increased antibiotic dose, and the seriousness of her peritonitis were the causes of leucocytopenia. Therefore, we stopped the antibiotic administration. Acinetobacter was detected in blood cultures. Symptoms of ileus then appeared and IVH (intravenous hyperalimentation) was started, while CAPD was changed to HD (hemodialysis). However, no increase in her WBC was achieved. When rhG-CSF (75μg/day) was administered subcutaneously, a marked increase in the WBC was found. On the 12th day following rhG-CSF administration, a peak of 138, 000/mm3 was observed. Administration of the antibacterial agent was resumed and the patient's inflammatory findings improved. The ileus resolved, her general condition improved, and she was discharged after 3 months of hospitalization. RhG-CSF was considered to be very useful in the treatment of granulocytopenia associated with CAPD peritonitis.
