Splenic infarction: an unrecognized cause of culture-negative peritonitis in a continuous ambulatory peritoneal dialysis patient

The appearance of cloudy peritoneal dialysis effluent in combination with the clinical manifestations of peritonitis usually heralds infectious peritonitis and the diagnosis is established with routine cultures. However, patients may present with culture-negative cloudy dialysate effluent and after ruling out atypical infectious etiologies, other intraabdominal causes should be considered in the differential diagnosis. A 57-year-old male with uremia on continuous ambulatory peritoneal dialysis with a pertinent history of restrictive cardiomyopathy and chronic atrial fibrillation suffered from abdominal pain and persistent culture-negative cloudy peritoneal dialysate. Clinical improvement was limited after empiric antibiotic treatment and all bacteriologic workups were negative. Isolated spleen infarction, a rare cause of culture-negative peritonitis, was disclosed by abdominal computed tomography. Spleen infarction is still an unrecognized cause of culture-negative peritonitis and is frequently overlooked. A high degree of suspicion is needed in CAPD patients with thromboembolism risk who present with unexplained persistent abdominal pain and cloudy PD effluent.