Successful treatment of fulminant encapsulating peritoneal sclerosis following fungal peritonitis with tamoxifen

Abstract

Encapsulating peritoneal sclerosis remains a serious complication of peritoneal dialysis. Prolonged duration on dialysis and severe episodes of peritonitis are the two most important risk factors for developing the condition. Here we describe a patient who developed a fulminant form of encapsulating peritoneal sclerosis soon after suffering from an episode of fungal peritonitis. There was clinical evidence of ongoing inflammation and gross malnutrition. Signs of chronic intestinal stasis were present on radiological imaging. There was concern in this situation that symptoms could partly relate to ongoing peritoneal sepsis, which could be worsened by immunosuppressives such as steroids. Tamoxifen was used without steroids in our patient with prompt resolution of stasis symptoms and withdrawal of artificial nutrition support. To our knowledge tamoxifen has never been previously used alone, in this scenario. We propose that tamoxifen might be a safer alternative to use in this clinical setting where there is concern about presence of ongoing sepsis, than corticosteroids and immunosuppressive agents.