Successful Treatment of Peritoneal Dialysis-related Peritonitis due to Mycobacterium iranicum

Area of Science:

• Microbiology
• Nephrology
• Infectious Diseases

Background:

• Peritonitis is a serious complication for patients undergoing peritoneal dialysis (PD).
• Nontuberculous mycobacteria (NTM) are an uncommon but significant cause of PD-related peritonitis.
• Early and accurate diagnosis is crucial for effective management.

Observation:

• A 68-year-old male PD patient presented with symptoms of peritonitis.
• Ziehl-Neelsen staining was positive for acid-fast bacilli, while Mycobacterium tuberculosis PCR was negative.
• Genetic analysis identified the causative agent as Mycobacterium iranicum.

Findings:

• The patient received a combination of oral and intraperitoneal antibiotics, including levofloxacin, clarithromycin, imipenem, and minocycline based on susceptibility testing.
• Treatment lasted for 6 months.
• The patient recovered from peritonitis, and PD therapy was successfully continued without the need for catheter removal.

Implications:

• This case represents the first reported instance of PD-related peritonitis caused by Mycobacterium iranicum.
• Successful management of NTM peritonitis with oral and intraperitoneal antibiotics is possible, preserving the PD catheter.
• Highlights the importance of considering NTM in the differential diagnosis of peritonitis in PD patients and guiding therapy with susceptibility testing.