Peritoneal Dialysis Catheter-Associated Peritonitis Caused by Mycobacterium abscessus: A True Infection?

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritonitis is a serious complication of peritoneal dialysis (PD), often treated with antibiotics.
• Atypical mycobacterial infections, particularly Mycobacterium abscessus, are increasingly recognized as emerging pathogens.

Observation:

• A 9-year-old male with trisomy 21 and end-stage renal disease (ESRD) presented with persistent peritonitis despite antibiotic treatment.
• Bloody PD fluid and lack of response to intraperitoneal antibiotics prompted further investigation.

Findings:

• Intraoperative peritoneal fluid culture revealed Mycobacterium abscessus (M. abscessus).
• Surgical removal of the PD catheter resulted in significant clinical improvement without further antimicrobial therapy.
• The patient subsequently underwent a successful kidney transplant.

Implications:

• Culture-negative peritonitis unresponsive to standard antibiotics warrants consideration of atypical mycobacterial infection.
• Contaminated PD catheters can serve as a source for M. abscessus peritonitis.
• Early diagnosis and catheter removal are crucial for managing M. abscessus peritonitis in PD patients.