title: Acute peritonitis due to Corynebacterium ulcerans in a patient receiving continuous ambulatory peritoneal dialysis: a case report and literature review.
abstract: A 55-year-old Japanese woman receiving continuous ambulatory peritoneal dialysis (CAPD) was admitted to our service with abdominal pain and cloudy peritoneal fluid. Laboratory data revealed a white blood cell count of 7.20 × 10(9 )cells/L, hemoglobin 9.8 g/dl, hematocrit 29.0%, platelet count 284 × 10(9 )cells/L, and C-reactive protein (CRP) 0.109 g/L. Peritoneal fluid white blood cell count of 2,000 cells/µl suggested acute peritonitis. An empiric trial of cefazolin and ceftazidime, subsequently switched to meropenem, vancomycin, minocycline, and amikacin, did not improve the patient's symptoms. The peritoneal fluid collected before initiation of antibiotic therapy grew Corynebacterium ulcerans. Ampicillin/sulbactam was started based on the culture and sensitivity data. On hospital day 8, the CAPD catheter was removed due to no clinical improvement and persistently increased levels of CRP to 0.0174 g/L. A 14-day course of ampicillin/sulbactam improved her clinical condition and laboratory data. Microbiological analysis revealed that C. ulcerans isolated from this patient did not produce diphtheria toxin. C. ulcerans was not isolated from her dog's oral and nasal cavities during a search for the route of her infection. We recommend that in patients with peritoneal dialysis, special attention should be paid to Corynebacterium peritonitis, especially due to C. ulcerans, which may produce diphtheria toxin, be resistant to multiple antibiotics, and frequently become recurrent.
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute-cho, Aichi 480-1195, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Kimura
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suga
authors.forename: Natsuko
authors.initials: N
authors.lastname: Suzuki
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Maeda
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Wataru
authors.initials: W
authors.lastname: Kitagawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Miura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morita
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Imai
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003352:Corynebacterium / Q000472:pathogenicity*; D003354:Corynebacterium Infections / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D004285:Dogs; D005260:Female; D006801:Humans; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents