Aspergillus oryzae Peritonitis in a Patient Undergoing Peritoneal Dialysis

Fungal peritonitis is a rare but serious complication of peritoneal dialysis that is associated with high morbidity and mortality. Candida species are the predominant pathogens, whereas Aspergillus peritonitis is less common but often fatal. We report a rare case of Aspergillus oryzae peritonitis in a 54-year-old man undergoing continuous ambulatory peritoneal dialysis for diabetic end-stage renal disease. The patient presented with turbid peritoneal dialysate containing fibrinous debris and had a prior history of Enterobacter cloacae peritonitis. Laboratory tests showed elevated C-reactive protein level and increased peritoneal white blood cell count. Empirical intraperitoneal ceftazidime and systemic fluconazole were initiated without clinical improvement. A positive serum galactomannan antigen test prompted the initiation of voriconazole. The Tenckhoff catheter was removed, and hemodialysis was resumed. Fungal cultures subsequently grew Aspergillus species, identified as A oryzae by polymerase chain reaction. The patient's symptoms improved with oral voriconazole, and he was discharged in stable condition. This case represents only the second reported instance of continuous ambulatory peritoneal dialysis-related A oryzae peritonitis. It underscores the importance of early consideration of fungal pathogens in refractory peritonitis and highlights the role of non-culture-based fungal biomarkers such as galactomannan in facilitating prompt diagnosis and timely antifungal therapy to improve outcomes.