Abstract: SA-PO964

Rapidly Growing Mycobacteria (RGM) – An Unusual Cause of Peritoneal-Dialysis Associated Mycobacterial Peritonitis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Khan, Nasir, Yale School of Medicine, New Haven, Connecticut, United States
  • Jorge Cabrera, Valerie, Yale School of Medicine, New Haven, Connecticut, United States
  • Dahl, Neera K., None, Madison, Connecticut, United States
Background

Non-tuberculous mycobacteria are a rare but serious cause of peritoneal dialysis-related peritonitis. M.chelonae, a member of the rapidly growing non-tuberculous mycobacteria (RGM) group, is an atypical organism mostly found in soil and water and known to cause skin and soft tissue infections. We present a case of M.chelonae infection manifested with chronic skin lesions and peritonitis in a diabetic peritoneal dialysis patient.

Methods

A 54 year old African American male developed 2 nodular lesions on the mid abdominal area. His past medical history included diabetes, hypertension and end-stage renal disease due to diabetic nephropathy. He had been started on peritoneal dialysis (PD) around 2 years ago. Over the course of 7 months these nodular skin lesions developed intermittent purulent discharge. Wound cultures, including fungal and acid-fast bacilli (AFB) cultures were repeatedly negative. Several days prior to admission, his peritoneal effluent became cloudy without any systemic symptoms. Two ulcerated nodules with purulent drainage were noted on the mid abdominal area. Peritoneal fluid cell count showed 4256 nucleated cells. Computed tomography (CT) of the abdomen confirmed the lesions to be interconnecting. A discrete 1.5 x 2.5 cm collection was also reported along the peritoneal catheter track. Four days later preliminary peritoneal fluid cultures revealed gram-positive acid fast bacilli, later identified as M.chelonae. The PD catheter was surgically removed and the patient was transitioned to hemodialysis. Deep wound cultures obtained in the operating room also confirmed the diagnosis. He was started on a 4-month course of Tigecycline and Amikacin based on culture sensitivities.

Conclusion

M.chelonae characteristically causes chronic nodular lesions with a purple discoloration. Very few cases of M.chelonae peritoneal dialysis-related peritonitis have been reported. Mainstay of treatment is removal of the source as well as antibiotics. A high level of suspicion for organisms such as fungi and non-tuberculous mycobacteria should be maintained in peritoneal dialysis patients with routine negative dialysate cultures who are unresponsive to standard empirical antibiotics.