Case Report: Peritoneal dialysis-associated peritonitis caused by Brucella

Brucella can affect multiple organs in the body, with peritonitis being a rare complication primarily observed in patients with cirrhosis or undergoing peritoneal dialysis. We aim to analyse the clinical features of patients with peritoneal dialysis-associated peritonitis to provide a reference for clinical diagnosis and treatment.

A retrospective analysis was performed on three cases of Brucella-associated peritonitis in patients undergoing peritoneal dialysis, who were admitted to the First People's Hospital of Kashi Prefecture between January 2022 and June 2025. The analysis covered general data, epidemiological history, clinical features, laboratory tests, and treatment efficacy.

All three patients had been in contact with animals or had drunk raw milk. Two were male and one was female. The patients were aged 36, 40, and 50 years old. They were all on peritoneal dialysis, and the main symptoms were abdominal pain, abdominal distension, and malaise, with no fever. All three patients had low leukocyte counts in their blood, a normal or mildly elevated neutrophil ratio, significantly elevated C-reactive protein levels, and mildly elevated procalcitonin levels. Peritoneal effluent showed >100 leukocytes/mm³ and a differential leukocyte count with a high proportion of mononuclear cells. Brucella was cultured from all peritoneal effluent samples, confirming the diagnosis of Brucella peritonitis. Symptoms decreased or disappeared following effective anti-infective treatment in all patients.

Brucella peritonitis occurs in patients undergoing peritoneal dialysis and is characterised by abdominal pain and pressure. The basis for confirming the diagnosis is the presence of elevated leukocytes, predominantly monocytes, in the peritoneal effluent, and the culture of Brucella in the peritoneal effluent. Effective treatment involves a combination of doxycycline and rifampicin for at least 6 weeks, which controls peritonitis without requiring the removal of the peritoneal dialysis catheter.