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Cryptococcal peritonitis in peritoneal dialysis patients: a case report
1Department of Medicine, University of Rochester, New York 14642.
Abstract:
Peritonitis in patients on chronic peritoneal dialysis remains a major problem. Most commonly this is due to bacterial infection, but fungal peritonitis is also a treatment dilemma. Peritonitis due to Cryptococcus neoformans is an unusual event, with fewer than ten cases reported. This case report documents a case of cryptococcal peritonitis in a diabetic man on prednisone and azathioprine for suspected chronic inflammatory demyelinating polyneuropathy. The organism was also cultured in the cerebrospinal fluid and urine and high cryptococcal antigen titers were found in the blood indicating systemic infection. The peritoneal catheter was removed, immunosuppression was withdrawn and he was treated with systemic antifungal therapy. He died suddenly nine weeks following the diagnosis and at post mortem was found to have evidence of cryptococcosis in lung, spleen and brain. The case demonstrates that cryptococcal peritonitis in patients on peritoneal dialysis should prompt a search for systemic infection and may require prolonged therapy.
Insights
Cryptococcal peritonitis in patients on peritoneal dialysis is rare but serious. This case highlights the need to screen for systemic Cryptococcus neoformans infection and manage immunosuppression carefully.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Peritonitis is a significant complication for patients undergoing chronic peritoneal dialysis.
- Fungal peritonitis presents treatment challenges, with Cryptococcus neoformans peritonitis being exceptionally rare.
Observation:
- A case of Cryptococcus neoformans peritonitis occurred in a diabetic patient receiving prednisone and azathioprine for suspected chronic inflammatory demyelinating polyneuropathy.
- The patient exhibited systemic infection with C. neoformans, confirmed by cultures in cerebrospinal fluid and urine, and high blood cryptococcal antigen titers.
Findings:
- Despite catheter removal, immunosuppression withdrawal, and systemic antifungal treatment, the patient died nine weeks post-diagnosis.
- Autopsy revealed disseminated cryptococcosis affecting the lungs, spleen, and brain.
Implications:
- Cryptococcal peritonitis in peritoneal dialysis patients necessitates a thorough investigation for systemic C. neoformans infection.
- Management may require extended antifungal therapy and careful consideration of immunosuppressive medications.