Cryptococcal peritonitis: report of a case developing during continuous ambulatory peritoneal dialysis and review of the literature

A patient developed cryptococcal peritonitis with systemic dissemination during continuous ambulatory peritoneal dialysis (CAPD). This case prompted a search of the literature for cases of cryptococcal peritonitis; 19 previously reported cases were identified. On the basis of their clinical characteristics, these cases were divided into two groups. Group 1 included 10 cases developing during CAPD. Treatment consisted of removal of the peritoneal dialysis catheter and administration of a short course of amphotericin B. Eight of the 10 cases had a benign course, and nine patients survived. Group 2 comprised 10 cases developing in patients with severe underlying illnesses, such as chronic liver disease, AIDS, systemic lupus erythematosus, and leukemia. Disseminated cryptococcosis was documented in eight of the nine patients in this group for whom relevant information was available. Seven patients died, some despite antifungal therapy. Cryptococcal disease may have protean manifestations and an insidious course. Accordingly, the diagnosis of cryptococcal peritonitis may well be delayed. An awareness of this entity may lead to earlier diagnosis and treatment and possibly to improved outcome.