Overview
Eosinophilic peritonitis is a rare condition characterized by the accumulation of eosinophils in the peritoneal cavity, often associated with systemic eosinophilic disorders or localized inflammatory processes affecting the peritoneum. 12Diagnosis
Elevated eosinophil count in peritoneal fluid
Clinical symptoms may include abdominal pain, ascites, and signs of peritonitis
Imaging studies (e.g., CT, ultrasound) to assess peritoneal involvement
Exclusion of other causes of eosinophilia through comprehensive clinical evaluation 1Management
First-line: Systemic glucocorticoids (e.g., prednisone) to control eosinophilic inflammation 1
Adjunctive:
- Biologic agents targeting interleukin-5 (IL-5) pathway, such as mepolizumab, to reduce reliance on systemic glucocorticoids and mitigate adverse effects 12
- Close monitoring for tapering of glucocorticoids under expert guidance 1Special Populations
Pregnancy: Limited evidence; management typically involves cautious use of glucocorticoids with close monitoring; biologic agents are generally avoided due to safety concerns 1
Pediatrics: Specific dosing and safety data scarce; individualized treatment plans with close follow-up recommended 1
Elderly: Increased vigilance for glucocorticoid-related side effects; consider early initiation of biologic agents to minimize steroid exposure 1Key Recommendations
Initiate treatment with systemic glucocorticoids for controlling eosinophilic inflammation in eosinophilic peritonitis (Evidence: Strong 1).
Consider early introduction of biologic agents targeting IL-5, such as mepolizumab, to reduce systemic glucocorticoid use and prevent adverse effects (Evidence: Moderate 12).
Tailor treatment plans in special populations, particularly emphasizing close monitoring in pregnant women, pediatric patients, and the elderly to manage risks effectively (Evidence: Expert opinion 1).References
1 Del Pozo V, Bobolea I, Rial MJ, Espigol-Frigolé G, Solans Laqué R, Hernández-Rivas JM et al.. Expert consensus on the use of systemic glucocorticoids for managing eosinophil-related diseases. Frontiers in immunology 2023. link
2 Pavord ID, Bel EH, Bourdin A, Chan R, Han JK, Keene ON et al.. From DREAM to REALITI-A and beyond: Mepolizumab for the treatment of eosinophil-driven diseases. Allergy 2022. link