Abstract：
A 65-year-old woman on peritoneal dialysis (PD) was admitted due to abdominal pain with cloudy PD effluent. The white blood cell count in PD effluent was 5860/µL with 85% polymorphonuclear neutrophils. Therefore, she was clinically diagnosed with peritonitis. The cultures of PD effluent were negative. Initial abdominal computed tomography did not find suggest any intraabdominal pathology. The patient was treated with empirical intraperitoneal antibiotics. Because abdominal pain with cloudy PD effluent persisted, the PD catheter was removed eventually. The culture of the removed PD catheter grew Klebsiella pneumoniae. However, intermittent fever was noted over the following days and empyema developed approximately 2 weeks after PD catheter removal. The culture of pleural fluid also grew K. pneumoniae. Another computed tomography revealed multiple intraabdominal abscesses that was assumed to come from a complication of PD-associated peritonitis. We postulate that the empyema might be caused by transdiaphragmatic extension of the intraabdominal abscesses into the pleural space.
摘要：
一名65岁的腹膜透析（PD）妇女因腹痛和浑浊的PD流出物而入院。PD流出物中的白细胞计数为5860/μL,具有85%的多形核中性粒细胞。因此,临床诊断为腹膜炎.PD流出物的培养为阴性。最初的腹部计算机断层扫描未发现任何腹内病理。患者接受经验性腹膜内抗生素治疗。因为腹痛伴有昏暗的PD流出物持续存在，最终移除PD导管.移除的PD导管的培养物生长肺炎克雷伯菌。然而,随后几天出现间歇性发热,在PD导管拔除后约2周出现脓胸.胸膜液的培养物也生长肺炎克雷伯菌。另一种计算机断层扫描显示多个腹内脓肿，被认为是由PD相关腹膜炎的并发症引起的。我们推测脓胸可能是由于腹内脓肿经diagraphic伸入胸膜腔引起的。
