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A unique case of Salmonella typhi peritonitis in a CAPD patient
Praveen Sandeep Raj1, Priya Subashchandrabose2, Milly Mathew3
1Department of Nephrology, MGM HealthCare, Aminjikarai, Chennai, Tamil Nadu, 600029, India.
Insights
Salmonella typhi peritonitis is a serious complication for patients on continuous ambulatory peritoneal dialysis (CAPD). This case highlights the challenges in managing refractory peritonitis and its potential long-term consequences.
Area of Science:
- Nephrology
- Infectious Diseases
- Dialysis Medicine
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a vital renal replacement therapy.
- Peritonitis remains a significant complication, impacting patient morbidity and mortality.
- Salmonella typhi peritonitis presents unique management challenges in CAPD patients.
Observation:
- A 57-year-old female on CAPD for four years developed Salmonella typhi peritonitis.
- Intraperitoneal antibiotic therapy yielded an unsatisfactory response.
- Peritoneal dialysis catheter removal and transition to hemodialysis were necessary.
Findings:
- Despite a prolonged course of intravenous antibiotics and catheter re-implantation, peritoneal membrane failure occurred.
- The patient ultimately continued on hemodialysis.
- The case resulted in a fatal outcome.
Implications:
- Refractory Salmonella typhi peritonitis can lead to irreversible peritoneal membrane damage.
- Management requires a multidisciplinary approach, potentially involving catheter removal and dialysis modality change.
- This case underscores the critical need for effective peritonitis prevention and treatment strategies in CAPD.
Abstract:
Peritonitis is the Achilles heel of continuous ambulatory peritoneal dialysis (CAPD) leading to significant morbidity and mortality. We report a 57 year old lady with coronary artery disease, pulmonary hypertension and diabetic kidney disease on CAPD for four years, who presented with Salmonella typhi peritonitis. As response to intraperitoneal antibiotics was unsatisfactory, the peritoneal dialysis catheter was removed after five days and shifted to maintenance hemodialysis. Following resolution of infection after a prolonged course of intravenous antibiotics, a swan neck catheter was re-implanted after eight weeks. There was peritoneal membrane failure and hence she continued on hemodialysis but she succumbed.
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