montelukast and Peritonitis

Eosinophilic peritonitis is a recognised complication of peritoneal dialysis and has an incompletely understood pathophysiology. Current treatment options, including change of dialysate, change of peritoneal dialysis modality, steroids or antihistamines, are supported only by case reports with a lack of controlled trials or evidence-based guidelines. Leukotrienes are proinflammatory arachidonic acid metabolites produced by leucocytes and are involved in eosinophil chemotaxis. Montelukast is an orally administered leukotriene receptor antagonist commonly used in managing childhood atopic illnesses and theoretically safe for use in patients with renal failure.. We describe the first reported case of recurrent, symptomatic, eosinophilic peritonitis in a 15-year-old girl successfully treated with leukotriene receptor antagonist montelukast after changes in dialysate and treatment with antihistamines failed to adequately control eosinophilic peritoneal infiltrates or symptoms.. Current scientific understanding of leukotrienes and eosinophil migration suggest that montelukast may be a well-tolerated, safe and efficacious treatment for eosinophilic peritonitis complicating peritoneal dialysis. Further cases and comparative studies are required to develop an evidence base for treatment of this condition.

Topics: Acetates; Adolescent; Cyclopropanes; Eosinophilia; Female; Humans; Leukotriene Antagonists; Peritoneal Dialysis; Peritonitis; Quinolines; Sulfides

Leukotrienes play a role in inflammation, and their participation in airway inflammation and bronchoconstriction in patients with severe asthma can be ameliorated by a new class of drugs known as leukotriene modulators. The role of leukotrienes in increasing vascular permeability in experimental peritonitis and in inducing chemotaxis of inflammatory cells has recently been documented. Steroids have been incriminated in the development of bacterial translocation in animal models in association with the suppression of mucosal immunity. The development of spontaneous bacterial peritonitis is recognized in cirrhotic patients with ascites and in those with nephrotic syndrome. The onset of bacterial peritonitis in the absence of these predisposing conditions or other underlying cause, such as perforated viscus, is termed 'primary bacterial peritonitis', and has never been described in asthmatic patients. We present an asthmatic patient who developed primary bacterial peritonitis while receiving a leukotriene modulator in combination with prednisolone therapy. The hypothesis that leukotriene receptor blockade might predispose to the development of primary bacterial peritonitis in patients receiving steroid therapy is discussed.

Topics: Acetates; Aged; Anti-Inflammatory Agents; Asthma; Cyclopropanes; Drug Therapy, Combination; Escherichia coli Infections; Female; Humans; Leukotriene Antagonists; Peritoneal Lavage; Peritonitis; Prednisolone; Quinolines; Sulfides