Novel Use of Intraperitoneal Acyclovir for Herpes Simplex Virus 2-Related Viral Peritonitis: A Case Report
Bibliographic record
Abstract
Introduction: Viral etiologies for peritonitis can be misclassified as culture negative peritonitis due to poor accessibility of viral testing in the effluent fluid. Inaccurate diagnosis and subsequent ineffective treatment can lead to unnecessary catheter removal for presumed refractory peritonitis. We present the only reported case of herpes simplex virus-2 (HSV-2) related PD peritonitis that was successfully treated with intraperitoneal (IP) acyclovir. Case Description: A 73-year old female on continuous cyclic peritoneal dialysis with a past medical history relevant for HSV-2 genital lesions presented with a cloudy effluent, elevated effluent WBC count with lymphocytic predominance and a recent HSV-2 flare. Initially thought to be culture negative peritonitis but no reduction was seen in cell count on empiric IP cefazolin and ceftazidime. Effluent was sent for viral culture on day 8 and discovered to be positive for HSV-2 via PCR on day 12. Oral acyclovir was used initially but then converted to intraperitoneal route to minimize adverse events. IP acyclovir was reconstituted in a 2.5% Dianeal bag and administered for 14 days based on pharmacokinetic data to achieve serum levels similar to intravenous administration. Patient’s cell counts improved and repeat effluent testing was negative for HSV-2 on day 27. Patient had no symptoms of neurotoxicity. Discussion: Culture negative peritonitis can account for up to 20% of peritonitis cases however the effluent is largely just tested for bacterial and fungal presence. Clinicians should be aware to the possibility of viral peritonitis in patients with refractory culture negative peritonitis, especially if risk factors such as a history of HSV infection are present. Early recognition and timely initiation of antivirals may prevent inadvertent catheter removal for presumed refractory peritonitis and help retain patients on PD. Most importantly, utilizing IP route of administration for acyclovir may lead to lower drug related toxicity whilst achieving therapeutic serum concentrations and allow for ongoing outpatient management of home dialysis patients on PD.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".