Fungal peritonitis caused by Lecythophora mutabilis

Area of Science:

• Medical Mycology
• Infectious Diseases
• Nephrology

Background:

• Fungal peritonitis is a serious complication in patients undergoing peritoneal dialysis (PD).
• Lecythophora mutabilis is a rare mold, infrequently implicated in human infections.

Observation:

• A patient on continuous ambulatory peritoneal dialysis (CAPD) presented with symptoms of peritonitis.
• Clinical, microbiological, and serological findings confirmed infection with Lecythophora mutabilis.
• Initial treatment included oral ketoconazole, intraperitoneal miconazole, and PD catheter replacement.

Findings:

• In vitro antifungal susceptibility testing showed significant variability in agent activity against L. mutabilis.
• The patient experienced a relapse despite initial therapeutic interventions.
• Complete resolution was achieved after a second PD catheter removal and extended imidazole treatment.

Implications:

• This case highlights L. mutabilis as a potential pathogen in PD-associated fungal peritonitis.
• Antifungal susceptibility testing is crucial for guiding effective treatment of L. mutabilis infections.
• Management may require aggressive approaches, including catheter removal and prolonged antifungal therapy.