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Neisseria mucosa Peritonitis in the Setting of a Migrated Intrauterine Device

Kiran Nawaz Khan1, Ramesh Saxena1, Michael Choti2

  • 1Division of Nephrology, University of Texas Southwestern, Dallas, Texas, U.S.A.

Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|November 28, 2018
PubMed

Insights

Peritonitis in peritoneal dialysis (PD) patients can be serious. This case highlights Neisseria mucosa peritonitis caused by a translocated intrauterine contraceptive device (IUCD), successfully treated without PD catheter removal.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Peritonitis is a significant complication for patients undergoing peritoneal dialysis (PD), frequently necessitating a transition to hemodialysis (HD).
  • Common causes include touch contamination and PD catheter-related infections, while intra-abdominal pathology is less frequent.
  • Neisseria mucosa is an uncommon pathogen implicated in PD-related peritonitis.

Observation:

  • A 30-year-old female on nocturnal intermittent PD presented with peritonitis.
  • The infection was linked to a translocated intrauterine contraceptive device (IUCD) that migrated through the abdominal wall.
  • The patient had an unusual case of Neisseria mucosa peritonitis.

Findings:

  • The patient underwent laparoscopic removal of the translocated IUCD.
  • Initial treatment involved empiric intraperitoneal (IP) vancomycin and intravenous ceftriaxone.
  • Post-identification of N. mucosa, treatment was adjusted to IP ceftriaxone for 21 days, leading to peritonitis resolution.

Implications:

  • This case demonstrates successful management of N. mucosa peritonitis in a PD patient with a translocated IUCD.
  • Conservative management, including IUCD removal and targeted antibiotics, salvaged the PD catheter and avoided transition to HD.
  • Highlights the importance of considering intra-abdominal pathology and unusual organisms in refractory or recurrent PD peritonitis.

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