Acremonium spp. peritonitis in an infant.

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Medical Mycology

Background:

• Fungal peritonitis is a rare but severe complication in pediatric patients undergoing peritoneal dialysis (PD).
• Candida species are the most common fungal agents, often leading to significant morbidity and mortality.
• Treatment can be challenging, necessitating a high index of suspicion for early diagnosis and management.

Observation:

• A 7-month-old infant with Down syndrome, congenital heart disease, pulmonary hypertension, and congestive heart failure required PD for edema and hyponatremia.
• The infant developed Acremonium spp. peritonitis despite receiving broad-spectrum antibiotics and fluconazole.
• This presentation underscores the potential for non-Candida fungal infections in immunocompromised pediatric patients on PD.

Findings:

• Acremonium spp. was identified as the causative agent of peritonitis in this infant.
• Successful treatment involved the removal of the peritoneal dialysis catheter and administration of liposomal amphotericin B.
• This case demonstrates an effective therapeutic strategy for a rare fungal peritonitis etiology.

Implications:

• Highlights Acremonium spp. as a potential, albeit rare, cause of fungal peritonitis in pediatric PD patients.
• Emphasizes the need for considering a broader range of fungal pathogens beyond Candida in refractory or unusual cases.
• Suggests that aggressive management, including catheter removal and targeted antifungal therapy, is crucial for favorable outcomes in pediatric fungal peritonitis.