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Peritoneal eosinophilia associated with Paecilomyces variotii infection in continuous ambulatory peritoneal dialysis
B J Nankivell1, D Pacey, D L Gordon
1Department of Nephrology, Royal Newcastle Hospital, Australia.
Abstract:
A 65-year-old woman maintained on continuous ambulatory peritoneal dialysis (CAPD) presented with a 5-month history of intermittent cloudy bags and sterile peritoneal and peripheral blood eosinophilia, which failed to clear despite conventional antibiotics. Impaired catheter inflow and delayed effluent drainage gradually occurred and intracatheter streptokinase, administered to rectify catheter dysfunction, dislodged a catheter cast composed of fungal hyphae of Paecilomyces variotii. Fungal peritonitis and Paecilomyces fungemia ensued, which were treated with amphotericin B and catheter removal. Peripheral eosinophilia rapidly resolved. Paecilomyces is a saprophytic fungus found in soil and water that is capable of infecting prosthetic devices. Eosinophils may have accumulated in this case in response to particulate fungal cell antigens being washed into the peritoneal cavity during dialysis. Chronic fungal catheter infection should be excluded in cases of late onset, persistant peritoneal eosinophilia on CAPD.
Insights
A fungal infection caused cloudy dialysis fluid and high eosinophil counts in a CAPD patient. Prompt treatment with antifungals and catheter removal resolved the infection and eosinophilia.
Area of Science:
- Nephrology
- Mycology
- Infectious Diseases
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Patients on CAPD are susceptible to various infections, including bacterial and fungal peritonitis.
- Sterile eosinophilia in peritoneal dialysis patients can be a diagnostic challenge.
Observation:
- A 65-year-old woman on CAPD presented with a 5-month history of cloudy dialysis bags and sterile eosinophilia.
- She experienced impaired catheter inflow and delayed drainage, unresponsive to antibiotics.
- Treatment with streptokinase dislodged a fungal cast (Paecilomyces variotii) from the catheter.
Findings:
- The patient was diagnosed with fungal peritonitis and Paecilomyces fungemia.
- Treatment involved amphotericin B and removal of the peritoneal dialysis catheter.
- Peripheral eosinophilia resolved rapidly after treatment initiation.
Implications:
- This case highlights Paecilomyces variotii as a cause of fungal peritonitis in CAPD patients.
- Persistent peritoneal eosinophilia in CAPD patients warrants exclusion of chronic fungal catheter infection.
- Early diagnosis and treatment are crucial for favorable outcomes in fungal peritonitis.