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Peritoneal mucormycosis in a patient receiving continuous ambulatory peritoneal dialysis
J R Polo1, J Luño, C Menarguez
1Department of General Surgery, Hospital General Gregorio Marañon, Madrid, Spain.
Abstract:
A 48-year-old man receiving maintenance hemodialysis for 3 years and continuous ambulatory peritoneal dialysis for 1 year developed a clinical picture compatible with peritonitis. Three successive fluid cultures were negative, and only after filtration of a large volume of peritoneal fluid a fungus identified as a Rhizopus sp was isolated in cultures of the filtering devices. The same fungus was also isolated from the peritoneal catheter cuff. Intravenous amphotericin B was administered and both the abdominal and general conditions of the patient improved transiently. Twenty days after initiation of antifungal treatment, a clinical suspicion of intestinal perforation arose and an exploratory laparotomy was scheduled, but the patient died during the anesthetic induction. The patient never received deferoxamine; any conditions predisposing to mucormycosis, such as diabetes or immunosuppression, were also absent.
Insights
A peritoneal dialysis patient developed a rare Rhizopus fungal infection. Despite treatment, the patient died, highlighting the challenges of diagnosing and managing invasive fungal infections in dialysis patients.
Area of Science:
- Nephrology
- Mycology
- Infectious Diseases
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a known complication of CAPD, often treated empirically.
- Fungal peritonitis is a rare but serious complication of CAPD.
Observation:
- A CAPD patient presented with peritonitis, but initial cultures were negative.
- Rhizopus sp. was isolated from peritoneal fluid after filtration and from the peritoneal catheter cuff.
- The patient showed transient improvement with amphotericin B but later developed suspected intestinal perforation.
Findings:
- This case highlights the diagnostic challenges of invasive fungal infections, particularly mucormycosis, in CAPD patients.
- Rhizopus sp. can cause peritonitis in CAPD patients, even without typical risk factors like diabetes or immunosuppression.
- Early diagnosis and aggressive treatment are crucial, but outcomes can still be poor.
Implications:
- Consider invasive fungal infections in CAPD peritonitis, especially with negative initial cultures.
- Filtration of large fluid volumes may aid in diagnosing rare fungal pathogens.
- Further research is needed to improve diagnostic and therapeutic strategies for fungal peritonitis in CAPD patients.