Abstract: FR-PO645
A Rare Presentation of an Unusual Fungus: Trichoderma Peritonitis
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 703 Dialysis: Peritoneal Dialysis
Authors
- Carlson, Jeremy, UF Health , Jacksonville, Florida, United States
- Staiano, Peter P., UF Health , Jacksonville, Florida, United States
- James, Leighton R., UF Health , Jacksonville, Florida, United States
Introduction
Peritoneal Dialysis (PD) can be an attractive modality for end stage renal disease (ESRD) patients. It does, however, require patients be responsible enough to safely perform their own dialysis care, otherwise they can develop peritonitis. Often there is a bacterial source, however, in rare cases fungal infections are seen and in these cases, mortality is higher. Trichoderma is an opportunistic fungus normally found on decaying wood, and it's presence in humans is especially rare and mainly limited to case reports, most of which surfacing in the last 10 years. This likely reflects the increasing number of relatively immunocompromised patients on PD and recent improvements in identifying pathogens. Presented is a rare case of PD associated Trichoderma peritonitis.
Case Description
A 48 year old Hispanic male with past medical history of diabetes mellitus, hypertension, and 1.5 years of PD presented to his nephrologist’s office with decreased appetite, abdominal pain, and cloudy effluent from his PD catheter. He was on his 3rd week of treatment with vancomycin and meropenem for gas gangrene diabetic foot ulcer infection. Intraperitoneal vancomycin was initiated for presumed PD peritonitis. PD effluent studies showed 1984 WBCs and mold culture growth, indicating fungal infection. He was immediately admitted for PD catheter removal, anti-fungal therapy with amphotericin B, and hemodialysis preparation with a tunnel catheter. Cultures finalized during his admission showed Trichoderma species susceptible to voriconazole, which he was switched to and discharged with a 1 month course.
Discussion
Peritonitis is a feared complication in PD patients as it can permanently ruin PD access as well as quickly develop into florid sepsis and death. This is especially true in fungal peritonitis cases, where all cause mortality is worse compared to bacterial counterparts. Nephrologists must remain vigilant in monitoring for signs and symptoms of peritonitis (mainly abdominal pain, fever, and cloudy effluent) at every office visit and maintain a low threshold for treatment and admission.
Risk factors specifically for fungal peritonitis include: HIV co-infection, recent treatment with antibiotics, or recent abdominal surgery/peritonitis. It is imperative when fungal peritonitis is diagnosed the catheter is removed and strong antifungals are started until susceptibilites are returned.