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Histoplasma Peritonitis: An Extremely Rare Complication of Peritoneal Dialysis

Asjad Sardar1, Bijin Thajudeen1, Pradeep V Kadambi2

  • 1Division of Nephrology, Department of Medicine, University of Arizona, Tucson, AZ, USA.

Case Reports in Nephrology
|June 5, 2018
PubMed

Insights

Fungal peritonitis is rare in peritoneal dialysis patients, with Histoplasma capsulatum infection being exceptionally uncommon. This case highlights the importance of considering unusual pathogens in peritonitis diagnosis and management.

Area of Science:

  • Nephrology
  • Mycology
  • Infectious Diseases

Background:

  • Bacterial peritonitis is a frequent complication of peritoneal dialysis (PD).
  • Fungal peritonitis is less common, typically caused by Candida species.
  • Peritonitis due to Histoplasma capsulatum is a rare occurrence in PD patients.

Observation:

  • A 63-year-old female on long-term PD presented with abdominal pain, fever, and altered mental status.
  • Clinical examination revealed abdominal tenderness; CT showed peritoneal membrane thickening.
  • PD fluid analysis confirmed peritonitis, with cultures identifying Histoplasma capsulatum.

Findings:

  • The patient's peritoneal dialysis fluid culture yielded Histoplasma capsulatum, confirming a rare fungal peritonitis.
  • Diagnosis was supported by leukocytosis and peritoneal membrane thickening on CT scan.

Implications:

  • Treatment involves antifungal therapy and prompt PD catheter removal if initial treatment fails.
  • Emerging antifungals may allow for medical management without immediate catheter removal in select cases.
  • Early recognition and appropriate management are crucial for successful outcomes in Histoplasma peritonitis.

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