Verticillium peritonitis in a patient on peritoneal dialysis
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G Amici1, S Grandesso, A Mottola
1Nephrology and Dialysis Division, Treviso Hospital, Italy.
Abstract:
We describe a case of peritonitis due to Verticillium spp. in a 33-year-old farmer on continuous ambulatory peritoneal dialysis (CAPD) for 3 months for end-stage renal failure due to chronic pyelonephritis. The etiologic agent was a hyaline hyphomycete which we report as a new human opportunistic pathogen. The fungus was isolated from the peritoneal fluid culture and from the tip of the catheter; identification was made on the basis of macroscopic and microscopic features. The patient had previously been admitted to our hospital for peritonitis caused by mixed enteric flora and treated for 8 days with intraperitoneal broad-spectrum antibiotic therapy. Five days after discharge he was readmitted for severe abdominal pain and cloudy drainage fluid. Two days of intraperitoneal broad-spectrum antimicrobial therapy produced no clinical improvement. Intravenous fluconazole and oral flucytosine were administered upon identifying the fungus. After another 2 days without improvement, peritoneal dialysis was discontinued and the catheter removed. Antimycotic therapy was continued for 4 days with complete resolution of the peritonitis. The patient chose to start hemodialysis and was discharged in good clinical condition.
Insights
A rare case of peritonitis caused by Verticillium spp. in a continuous ambulatory peritoneal dialysis (CAPD) patient highlights a new opportunistic fungal pathogen. Treatment involved antifungals and switching to hemodialysis for resolution.
Area of Science:
- Nephrology
- Mycology
- Infectious Diseases
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for end-stage renal failure.
- Peritonitis is a serious complication of CAPD, often caused by bacterial infections.
Observation:
- A 33-year-old farmer on CAPD developed recurrent peritonitis.
- The causative agent was identified as Verticillium spp., a hyaline hyphomycete, isolated from peritoneal fluid and catheter tip.
- Initial antibiotic therapy was ineffective, necessitating a change in treatment approach.
Findings:
- Verticillium spp. is reported as a novel opportunistic human pathogen.
- Antifungal treatment with intravenous fluconazole and oral flucytosine, followed by catheter removal and continued antimycotic therapy, led to complete peritonitis resolution.
- The patient transitioned to hemodialysis and was discharged in stable condition.
Implications:
- This case expands the spectrum of fungal pathogens associated with CAPD peritonitis.
- Highlights the importance of considering fungal etiologies in refractory peritonitis cases.
- Suggests the need for prompt identification and targeted antifungal therapy in CAPD-related infections.