Abstract
The International Society for Peritoneal Dialysis recommends the regular application of topical antibiotic-containing preparations in addition to a routine exit site care to reduce the risk of exit site infection (ESI). Among these prophylactic antimicrobial preparations, topical gentamicin is one of the widely used and effective antibiotics for prevention of ESI and peritonitis in peritoneal dialysis (PD) patients. Overall, topical gentamicin is well tolerated; however, its use can be associated with the development of allergic contact dermatitis (ACD). We describe a first reported case of PD catheter exit site contact ACD due to topical gentamicin mimicking ESI. The patient in this report developed worsening violaceous in color and pruritic rash surrounding the PD catheter exit site that appeared 3 weeks after the initiation of gentamicin cream. The association between development of rash and initiation of topical gentamicin led to a suspicion of local reaction to gentamicin rather than ESI. Skin biopsy confirmed ACD. Discontinuation of the provoking agent and subsequent treatment with topical hydrocortisone application led to a resolution of the exit site rash. Any rash at a PD catheter exit site should be considered infectious until proven otherwise. However, it is important to be aware of noninfectious etiologies of exit site rashes as the treatment of these 2 conditions differs.
Highlights
The development of rash at the peritoneal dialysis (PD) exit site is never trivial for nephrologists and is always concerning for PD exit site infection (ESI)
We describe for the first time a clinical presentation and diagnostic approach to gentamicin-induced contact dermatitis at the PD catheter exit site that mimicked ESI
ESI is typically diagnosed clinically based on the finding of purulent or bloody drainage from PD catheter exit site, surrounding erythema, tenderness, and swelling
Summary
The development of rash at the peritoneal dialysis (PD) exit site is never trivial for nephrologists and is always concerning for PD exit site infection (ESI). We describe for the first time a clinical presentation and diagnostic approach to gentamicin-induced contact dermatitis at the PD catheter exit site that mimicked ESI. A 54-year-old African American female was undergoing continuous cycling PD for end-stage renal disease due to diabetes. She presented to clinic with 2.5-week history of a worsening pruritic rash around her PD catheter exit site. Three weeks earlier she began topical gentamicin sulfate 0.1% cream for ESI prophylaxis. The patient reported no fever or abdominal pain. Mupirocin 2% cream was subsequently added for ESI prophylaxis with no recurrence of exit site rash
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