A47-01 Bilateral Pleuroperitoneal Fistula in a Patient With Systemic Lupus Erythematosus on Peritoneal Dialysis: A Rare Cause of Recurrent Pleural Effusion

Abstract Background Pleuroperitoneal communication (PPC) is a recognized but uncommon complication of peritoneal dialysis (PD), with reported incidence around 1.6 - 2% in patients undergoing Continuous Ambulatory Peritoneal Dialysis. According to one literature review, bilateral involvement is extremely uncommon (approximately 4% of PPC cases); most cases present as right-sided hydrothorax. Co-existent connective tissue disease such as systemic lupus erythematosus (SLE) is seldom emphasized in PPC literature, yet may pose additional diagnostic and management complexity. Case Presentation A 28-year-old woman with known SLE with lupus nephritis had been maintained on continuous ambulatory peritoneal dialysis for end-stage renal disease. She presented with progressive dyspnea and bilateral pleural effusions in which she was admitted. Thoracentesis yielded clear, transudative fluid with a pleural fluid glucose level exceeding serum glucose, raising suspicion for pleuroperitoneal communication. Bilateral pleuroperitoneal fistula were confirmed by contrast-enhanced computed tomography (CT) peritoneography, which shows suggestive of bilateral pleuroperitoneal communication, more severe on the left. The patient was switched to hemodialysis and PD was discontinued. Surgical correction was deferred due to the small size of the fistula and bilateral involvement. Conservative management with pleural drainage and discontinuation of PD resulted in resolution of effusions and clinical improvement. Discussion Increased in abdominal pressure allows the dialysate to enter the pleural space forming the pleuroperitoneal communication. In patients with SLE, where lupus pleuritis may present similarly, bilateral involvement is uncommon and presents a diagnostic challenge. Pleural fluid glucose greater than that of the serum glucose together with the imaging confirmation through CT peritoneography or peritoneal scintigraphy are diagnostic hints. Majority of the population responds to conservative management in fistula closure such as discontinuation of PD. In cases that are not responsive, pleurodesis or surgical repair may be necessary. In this case, conservative management was offered since the size of the fistula and small and knowing that the fistula is bilateral. This case highlights the importance of considering pleuroperitoneal communication as a differential diagnosis in PD patients presenting with recurrent or unexplained pleural effusion. Even though it is uncommon, bilateral disease can happen and should be treated with multidisciplinary care and prompt imaging. Understanding this entity can help with proper dialysis planning, avoid misdiagnosis, and enhance patient outcomes. This abstract is funded by: None