Peritoneal catheter colonization by Penicillium sp : Case report and review of penicillium-related complications in peritoneal dialysis

Abstract

Abstract Fungal peritonitis is an uncommon, serious complication of peritoneal dialysis, usually caused by Candida sp . Asymptomatic fungal colonization of the peritoneal catheter is less frequent. Penicillium sp have only rarely been reported as a cause of peritoneal complications in peritoneal dialysis. We report a case of fever and peritoneal catheter malfunction associated with catheter colonization by Penicillium sp , in the absence of signs or symptoms of acute peritonitis. Cultures of the dialysate grew Penicillium sp, and histological examination showed penetration of the catheter by hyphae. The peritoneal catheter was removed, and the patient was maintained on hemodialysis and oral itraconazole for 6 weeks before successfully returning to continuous cycling peritoneal dialysis (CCPD). One case of Penicillium catheter colonization and seven of Penicillium peritonitis in peritoneal dialysis patients have been previously published in the English literature. Detailed data were provided in five reports. Delayed diagnosis was frequent (mean ± SD 31 ± 24 days after the onset of symptoms). Peritonitis cases were treated with catheter removal and antifungal medications, and the outcome was always satisfactory. We conclude that Penicillium should be considered a pathogenic fungus, not a contaminant, when isolated from peritoneal dialysis specimens, and should be treated accordingly. However, Penicillium may colonize the peritoneal catheter in the absence of peritonitis, and the prognosis of Penicillium peritonitis is good despite a frequent delay in diagnosis.