title: Accelerated recovery from Candida peritonitis of enteric origin by early surgical drainage in a peritoneal dialysis patient.
abstract: A 62-year-old man on continuous ambulatory peritoneal dialysis was transferred to our hospital with recurrent abdominal pain and a cloudy peritoneal effluent. Three weeks before the transfer, his symptoms were successfully treated with broad-spectrum antibiotics. However, their effectiveness was lost for his recurrent symptoms. Fungal peritonitis was diagnosed because of an increased white blood cell count in the peritoneal fluid on admission and isolation of Candida albicans from a peritoneal fluid culture. Intravenous fos-fluconazole was immediately started, although it was ineffective for his deteriorating symptoms. The concomitant isolation of Candida albicans in a stool culture suggested that fungal peritonitis had an enteric origin. An emergency laparotomy revealed multiple diverticulosis and sigmoid colon diverticulitis. A surgical drainage was performed in addition to peritoneal catheter removal. Postoperatively, the patient's symptoms improved rapidly and there were no signs of recurrence with continuous administration of fos-fluconazole. Surgical drainage accelerated the recovery from fungal peritonitis. This patient is the first case showing the usefulness of stool culture in the diagnosis of fungal peritonitis secondary to prior bacterial peritonitis. This case also demonstrated the importance of laparotomy to confirm the enteric origin of the fungus, and the efficacy of early surgical drainage for the treatment.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan. kazaitsu@med.tohoku.ac.jp
authors.forename: Itsuro
authors.initials: I
authors.lastname: Kazama
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Muto
authors.forename: Makoto
authors.initials: M
authors.lastname: Inoue
authors.forename: Taro
authors.initials: T
authors.lastname: Fukui
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kotoda
authors.forename: Katsumi
authors.initials: K
authors.lastname: Takemura
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kimura
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ishikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Yagisawa
authors.forename: Wako
authors.initials: W
authors.lastname: Yumura
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D000935:Antifungal Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D002176:Candida albicans / Q000302:isolation & purification*; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D043963:Diverticulosis, Colonic / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D004322:Drainage; D005243:Feces / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents