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Mycobacterium septicum associated peritonitis: A case report
Nattawat Klomjit1, Api Chewcharat1, Margaret D'Uscio1
1Division of Nephrology and Hypertension, 4352Mayo Clinic, Rochester, MN, USA.
Abstract:
Although peritoneal dialysis (PD)-associated peritonitis secondary to mycobacterium is rare, the treatment is challenging and outcomes remain poor. We report the first case of PD-associated peritonitis secondary to Mycobacterium septicum. The patient is a 53-year-old Caucasian man who developed end-stage kidney disease due to systemic sclerosis. He was initially started on intermittent hemodialysis and was then switched to PD 10 months later. He presented with generalized abdominal pain and an increase in the number of nucleated cells and neutrophils in the dialysate effluent sample (854 total nucleated cells/µL and 512 neutrophils/µL). Ten days later, the fluid grew M. septicum, a rapidly growing nontuberculous mycobacterium (NTM). Once the organism was identified, he was treated with moxifloxacin and doxycycline, and the PD catheter was removed. Antibiotics were adjusted due to sensitivities profile and side effects, and he completed 4 months of antibiotic treatment with decreasing cell counts and negative PD fluid cultures. This case highlights the growing list of organisms responsible for NTM peritonitis and complexity of care in the patient with NTM peritonitis.
Insights
Peritonitis from Mycobacterium septicum is rare in peritoneal dialysis (PD) patients. This case shows successful treatment with antibiotics and catheter removal, highlighting challenges in managing nontuberculous mycobacterial infections.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritoneal dialysis (PD) is a crucial treatment for end-stage kidney disease.
- PD-associated peritonitis, while uncommon with mycobacteria, presents significant treatment challenges and poor outcomes.
- Nontuberculous mycobacteria (NTM) represent a growing list of causative agents for PD peritonitis.
Observation:
- A 53-year-old male on PD for end-stage kidney disease secondary to systemic sclerosis presented with abdominal pain and elevated inflammatory markers in PD effluent.
- Dialysate culture subsequently identified Mycobacterium septicum, a rapidly growing NTM.
Findings:
- The patient received a tailored antibiotic regimen including moxifloxacin and doxycycline after PD catheter removal.
- Treatment resulted in decreasing cell counts and negative PD fluid cultures.
- The patient completed 4 months of antibiotic therapy with a favorable outcome.
Implications:
- This case underscores the importance of considering NTM in PD peritonitis, even rare species like M. septicum.
- Early identification and appropriate antimicrobial therapy, alongside catheter management, are critical for successful treatment.
- Managing NTM peritonitis in PD patients requires a complex, individualized approach due to potential treatment challenges and variable outcomes.
