Asymptomatic Dialysate Turbidity and Repeated Intraductal Clots in a Peritoneal Dialysis Patient

A female patient underwent peritoneal dialysis for 2.5 years. She was found to have a constant turbid peritoneal dialysis effluent for 3 months without abdominal pain. Repeated routine tests of peritoneal effluent samples showed an elevated white blood cell count and an increased number of eosinophils. Additionally, a small black spot was found inside the Tenckhoff catheter. The presence of bacteria and fungi was negative by peritoneal fluid culture. Idiopathic eosinophilic peritonitis was considered, and oral corticosteroid treatment was administered. Soon after, the dialysis effluent became clear. However, eosinophilic peritonitis immediately relapsed after the corticosteroid therapy was suspended. Even worse, catheter dysfunction occurred, likely due to a clot that gradually formed from the spot. Finally, the catheter was removed, and a pathological examination was performed. It was revealed that the clot was composed of fungal spores and hyphae as well as eosinophils. This case reminds us that fungal peritonitis should be suspected when a clot forms.