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Mycobacterium avium complex peritonitis in a pediatric patient on peritoneal dialysis: A case report
Shunsuke Yokota1, Kentaro Nishi1, Sho Ishiwa1,2
1Division of Nephrology and Rheumatology.
Introduction:
Peritonitis due to Mycobacterium avium complex (MAC) is a rare but life-threatening complication in patients on peritoneal dialysis (PD). However, optimal therapeutic regimen, treatment duration, and appropriate timing of kidney transplantation (KT) after treatment are unknown.
Symptoms:
We herein report a 4-year-old boy on PD due to end-stage kidney disease resulting from bilateral hypoplastic kidneys. He was admitted for peritonitis complaining fever, abdominal pain, and cloudy peritoneal effluent on PD after accidentally biting and opening the PD catheter while in the bath. Initial treatment with vancomycin and ceftazidime for 2 weeks was successful, although peritonitis recurred 37 days after discharge.
Diagnosis:
Mycobacterial culture was positive 9 days after readmission, and MAC was grown in the PD culture on day 30. We diagnosed him with MAC peritonitis that occurred on PD.
Interventions:
Clarithromycin, ethambutol, and rifampicin were initiated. The PD catheter was removed, and hemodialysis was initiated with a cuffed catheter inserted in the internal jugular vein. Follow-up observation for 8 months after the cessation of 1-year anti-mycobacterial therapy confirmed no recurrence of MAC infection, and the patient received living-donor KT from his father.
Outcomes:
His renal function was stable, with no recurrence of MAC peritonitis at 2 years after the KT.
Conclusion:
To the best of our knowledge, this is the first report of a patient who successfully underwent KT after receiving treatment for MAC peritonitis. One-year anti-mycobacterial therapy, PD catheter removal, 8-month observation after the cessation of therapy led the successful KT, although further investigation is warranted to confirm the efficacy of this approach.
Insights
Mycobacterium avium complex (MAC) peritonitis in patients on peritoneal dialysis (PD) is rare. This case report details a successful kidney transplant (KT) after a 1-year treatment regimen for MAC peritonitis, demonstrating a viable therapeutic approach.
Area of Science:
- Nephrology
- Infectious Diseases
- Pediatric Medicine
Background:
- Peritonitis caused by Mycobacterium avium complex (MAC) is a rare but serious complication in patients undergoing peritoneal dialysis (PD).
- Optimal treatment strategies, including duration and timing for kidney transplantation (KT), remain undefined for MAC peritonitis in PD patients.
Observation:
- A 4-year-old boy on PD for end-stage kidney disease developed MAC peritonitis following accidental PD catheter contamination.
- Initial antibiotic treatment was successful, but peritonitis recurred, leading to diagnosis of MAC peritonitis via positive PD culture.
Findings:
- The patient underwent a 1-year course of multi-drug anti-mycobacterial therapy (clarithromycin, ethambutol, rifampicin) with PD catheter removal and transition to hemodialysis.
- Following treatment completion and an 8-month observation period without recurrence, the patient successfully received a living-donor kidney transplant.
Implications:
- This case presents the first successful KT in a patient treated for MAC peritonitis, suggesting a potential treatment pathway.
- A 1-year anti-mycobacterial therapy, catheter removal, and extended post-treatment observation may facilitate successful KT in MAC peritonitis patients, warranting further investigation.
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