Clofazimine in Mycobacterium abscessus peritonitis: A pediatric case report

Area of Science:

• Infectious Diseases
• Pediatric Nephrology
• Antimicrobial Therapy

Background:

• Nontuberculous mycobacteria (NTM) infections, including Mycobacterium abscessus, can cause peritonitis in patients on peritoneal dialysis (PD).
• Established treatment guidelines for M. abscessus peritonitis are lacking, particularly in pediatric populations.
• Clofazimine has shown efficacy as an adjunctive treatment for M. abscessus lung infections.

Observation:

• A child on PD presented with symptoms mimicking bacterial peritonitis, but with persistent symptoms and elevated inflammatory markers despite empirical treatment.
• Diagnosis of M. abscessus peritonitis was confirmed by positive bacterial culture of PD effluent after 5 days.
• The patient experienced complete symptom resolution within 6 days of initiating multidrug therapy.

Findings:

• Successful treatment of a pediatric case of M. abscessus PD peritonitis using a novel multidrug regimen including clofazimine, amikacin, and clarithromycin.
• Amikacin was discontinued after 6 weeks due to ototoxicity, while clarithromycin and clofazimine were continued for 9 months.
• Complete pathogen eradication was achieved prior to the patient's planned renal transplant.

Implications:

• This case suggests that clofazimine can be a valuable and safe adjuvant therapy for M. abscessus peritonitis in children on PD.
• A high index of suspicion is crucial for diagnosing NTM peritonitis, especially in refractory or culture-negative cases.
• Multidrug therapy, potentially including clofazimine, should be considered for M. abscessus infections in PD patients, necessitating further research.