47-year-old woman with a history of glycogenosis type V (McArdle's disease), Chiari malformation, chronic renal failure without filiation, retinal atrophy and arterial hypertension.
A peritoneal catheter was implanted on 19/5/2000 in another centre, and dialysis with a 2-litre infusion was started 15 days later. The patient presented from the beginning with abdominal discomfort, pleuritic pain in the right hemithorax and dyspnoea. A chest X-ray was performed, showing hydrothorax, which led to discontinuation of PD and referral to our hospital.

Drainage of the pleural effusion (transudate) was performed at our centre, with normalisation of the chest X-ray. PD was attempted again with a lower infusion volume and the pleural effusion reappeared shortly afterwards. Subsequently, an arteriovenous fistula (AVF) puncture was attempted but was complicated by extravasation of the AVF and myositis.
The patient refused haemodialysis or any other type of therapeutic option to resolve the pleuroperitoneal communication, so automatic peritoneal dialysis (APD) was started with low volume and high bedside in September 2000, achieving good drainage and with the appearance of small right pleural effusion on several occasions.
The patient remained on APD until August 2002, when she underwent a renal transplant, requiring transplantectomy due to thrombosis. In September 2002, she was again included in the PD programme, where she remained until she died at home in October 2003.
