Sevelamer crystal-associated peritonitis in a patient on continuous ambulatory peritoneal dialysis: a case report

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi 2023-08, Vol.29 (4), p.349-350
• Main Authors: Wong, Y H, Li, S M, Pak, W W L, Chan, K L, Chan, Z, Law, W P, Lam, C K, Wong, S S H
• Format: Article
• Language: English
• Subjects: Abdomen; Case reports; Catheters; Crystals; Dialysate; FDA approval; Hemodialysis; Intestinal obstruction; Kidney diseases; Patients; Peritoneal dialysis; Peritonitis; Ulcers
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj2210076

The patient underwent a left hemicolectomy but later succumbed in the intensive care unit due to hospital-acquired pneumonia. Stomach acid releases sevelamer polymer that binds phosphate in the intestine and forms a crystalline aggregate.1 Initially approved by the United States Food and Drug Administration in October 1998 as sevelamer hydrochloride, sevelamer has been largely replaced since 2007 by sevelamer carbonate.1 Sevelamer is commonly associated with gastrointestinal (GI) tract side-effects such as dyspepsia, abdominal pain, flatulence, and constipation.2 Sevelamer crystals (SCs) are non-polarised, have a broad curved and irregularly spaced fish-scale pattern, appear violet on periodic acid[-]Schiff staining, and have a two-tone yellowish/brownish colour on haematoxylin and eosin staining.1 About 19 cases of sevelamer-associated GI ulcers have been reported in the literature.3The lesion can be found in all segments of the GI tract although the colon is the most common site. Acknowledgement We thank Dr Ching-ki Fung and Dr Ngai-sheung Fung, pathologists of United Christian Hospital, for the detailed analysis of the colonic specimen and illustrative pathology images.