The "Silent" Threat: Group G Streptococcus Peritonitis in Peritoneal Dialysis

Peritoneal dialysis (PD) is a therapy for patients with end-stage renal disease (ESRD). PD carries an increased risk of peritonitis, often secondary to poor technique. A small subset of patients may present with "silent" peritonitis, or peritonitis in the absence of fever and abdominal pain, making diagnosis and treatment challenging. Identification of a causative organism can be an added barrier further delaying care. We present the case of a 95-year-old female with a history of ESRD on PD who presented with fatigue, confusion, and a lower leg wound found to have group G Streptococcus bacteremia. Treatment with intravenous antibiotics did not yield significant improvement, prompting the investigation of PD dialysate as a potential source. The patient was afebrile with persistent leukocytosis and no clinical signs of peritonitis. Yet, peritoneal fluid analysis confirmed peritonitis. This case underscores the importance of remaining cognizant of PD peritonitis in patients receiving PD therapy even in the absence of classic symptomatology. Risk factors such as advanced age, dementia, altered mentation from sepsis, or uncommon organisms may create an atypical presentation, delaying diagnosis and treatment. High rates of morbidity in peritonitis with concomitant bacteremia make early treatment even more crucial.