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Mycobacterium fortuitum Peritoneal Dialysis-Related Peritonitis in a Child: A Case Report
Tetsuya Sakaguchi1, Hiroshi Tamura1, Keishiro Furuie1
1Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Introduction:
Peritonitis is a significant complication of peritoneal dialysis (PD). Additionally, in severe or prolonged cases of peritonitis, the structure and function of the peritoneum may change, making it difficult to continue PD. Thus, identifying the causative agent and early administration of antibiotics are essential to minimize the risk of treatment failure. Meanwhile, bacterial peritonitis caused by nontuberculous Mycobacteria (NTM) are difficult to identify. NTM are also among the most difficult organisms to eradicate. Oftentimes, removal of the peritoneal catheter and multiple antibiotics are required to eradicate NTM infections.
Case Presentation:
Herein, we report a case of peritonitis caused by Mycobacterium fortuitum in a 3-year-old boy undergoing PD. The patient had a history of an initial PD catheter exit site infection caused by M. fortuitum that led to PD-associated peritonitis. Consequently, the catheter was removed, and the patient was switched to hemodialysis and treated with multiple antibiotics.
Conclusion:
This rare cause of peritonitis is associated with a high mortality and severe morbidity and usually requires removal of the PD catheter as well as prolonged treatment with multiple antibiotics. When there is NTM infection around the PD catheter, such as in an ulcer, it is necessary to remove the catheter and transition to a hemodialysis until the infection has healed.
Insights
Peritonitis from nontuberculous mycobacteria (NTM) is a serious complication of peritoneal dialysis (PD). Early identification and treatment are crucial, often requiring catheter removal for NTM infections.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a major complication of peritoneal dialysis (PD).
- Nontuberculous mycobacteria (NTM) cause difficult-to-diagnose and treat peritonitis.
- NTM infections often necessitate PD catheter removal and prolonged antibiotic therapy.
Purpose of the Study:
- To report a case of peritonitis caused by Mycobacterium fortuitum in a pediatric PD patient.
- To highlight the challenges in diagnosing and managing NTM peritonitis.
- To emphasize the importance of timely intervention in PD-related infections.
Main Methods:
- Case report of a 3-year-old boy undergoing PD.
- Documented initial PD catheter exit site infection with M. fortuitum.
- Described subsequent development of PD-associated peritonitis.
Main Results:
- The patient developed peritonitis due to M. fortuitum following an exit site infection.
- PD catheter removal and transition to hemodialysis were required.
- The patient received multiple antibiotics for treatment.
Conclusions:
- Mycobacterium fortuitum peritonitis is a rare but severe complication of PD.
- NTM peritonitis typically requires catheter removal and extensive antibiotic treatment.
- Prompt management is essential to prevent severe morbidity and mortality in PD patients with NTM infections.
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