AbstractA 13‐year‐old boy resumed peritoneal dialysis after the loss of a deceased donor renal transplant but was main‐tained on mycophenolate mofetil and monthly infusions of intravenous immunoglobulin to reduce his panel reactive antibody level. He developed low‐grade fever, cloudy fluid, and abdominal pain without peritoneal signs. His mother reported seeing some black “flakes” in his effluent. He was admitted and treated for presumed bacterial peritonitis twice with neither bacterial nor fungal growth on cultures. He received empiric antibiotics and appeared to respond partially. The patient remained asymptomatic with little abdominal pain, but had progressive difficulties with drain‐age. A black “speck” was obtained and identified as Curvularia. The peritoneal dialysis catheter was removed, and he was treated with both intravenous and intraperitoneal amphotericin B. This is the second case of peritonitis caused by Curvularia in a pediatric peritoneal dialysis patient reported in the literature. peritonitis is a serious complication of peritoneal dialy‐Fungal sis. Filamentous species such as Curvularia are uncommon, with a total of 10 reported cases. Although it has been reported as a disseminated infection, it is rarely pathogenic in humans. Of the 10 reported cases, 7 reported the pres‐ence of black proteinaceous material in the lumen of the Tenckhoff catheter. The most important measure in the treatment of peritonitis caused by Curvularia is removal of the peritoneal dialysis catheter. Curvularia species have been found to be susceptible in vitro to many antifungals, but there is no standard for therapy. Black “specks” in dialysate effluent should raise the level of concern for fungal peritonitis. Dial. Transplant. © 2010 Wiley Periodicals, Inc.