Abstract
Mycobacterium fortuitum is a ubiquitous, rapidly growing nontuberculous mycobacterium (NTM). It is the most commonly reported NTM in peritoneal dialysis (PD) associated peritonitis. We report a case of a 52-year-old man on PD, who developed refractory polymicrobial peritonitis necessitating PD catheter removal and shift to hemodialysis. Thereafter, M. fortuitum was identified in the PD catheter culture and in successive cultures of initial peritoneal effluent and patient was treated with amikacin and ciprofloxacin for six months with a good and sustained clinical response. Months after completion of the course of antibiotics, the patient successfully returned to PD. To our knowledge, this is the first reported case of M. fortuitum peritonitis in the field of polymicrobial PD peritonitis. It demonstrates the diagnostic yield of pursuing further investigations in cases of refractory PD peritonitis. In a systematic review of the literature, only 20 reports of M. fortuitum PD peritonitis were identified. Similar to our case, a delay in microbiological diagnosis was frequently noted and the Tenckhoff catheter was commonly removed. However, the type and duration of antibiotic therapy varied widely making the optimal treatment unclear.
Highlights
Bacterial peritonitis is the most common complication of peritoneal dialysis (PD) and often the reason for discontinuing this modality of renal replacement therapy
We describe the first case of nontuberculous mycobacterium (NTM) PD peritonitis caused by Mycobacterium fortuitum (M. fortuitum) in the field of polymicrobial PD peritonitis and a brief literature review concerning M. fortuitum peritonitis in PD patients
Mycobacterium fortuitum is the most commonly reported NTM associated with infection in PD patients
Summary
Bacterial peritonitis is the most common complication of peritoneal dialysis (PD) and often the reason for discontinuing this modality of renal replacement therapy. The vast majority of PD associated peritonitis cases are caused by aerobic bacteria, such as coagulase-negative staphylococci, Staphylococcus aureus, and Pseudomonas aeruginosa. Culture-negative peritonitis accounts for up to 30% of peritonitis cases [1]. Potential pathogens for this “culturenegative” peritonitis include mycobacteria and fungi. Failure to consider mycobacterial infection in the differential diagnosis of peritonitis may lead to delayed diagnosis and treatment, even to failure of PD. We describe the first case of NTM PD peritonitis caused by Mycobacterium fortuitum (M. fortuitum) in the field of polymicrobial PD peritonitis and a brief literature review concerning M. fortuitum peritonitis in PD patients
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