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Kidney Week

Abstract: PUB706

Candida albicans Peritonitis with Urgent Start Peritoneal Dialysis in a Patient with aHUS Treated with Eculizumab

Session Information

Category: Trainee Case Reports

  • 703 Dialysis: Peritoneal Dialysis


  • Han, Heedeok, University of Wisconsin, Madison, Wisconsin, United States
  • Alagusundaramoorthy, Sayee Sundar, University of Wisconsin, Madison, Wisconsin, United States
  • Gardezi, Ali I., University of Wisconsin, Madison, Wisconsin, United States
  • Chan, Micah R., University of Wisconsin-Madison, Fitchburg, Wisconsin, United States

Fungal peritonitis occurs in about 2-13% of patients who undergo peritoneal dialysis (PD). Although rare, fungal peritonitis is a very serious complication with high rates of hospitalization, catheter removal, transfer to hemodialysis and death. The most commonly isolated species with fungal peritonitis is candida sp., with Candida albicans being the most frequently isolated organism. Common risk factors associated with the development of fungal peritonitis include episodes of bacterial peritonitis, recent antibiotic use, and immunosuppression. Atypical hemolytic uremic syndrome (aHUS) is a hereditary disease process that occurs due to dysregulation in the complement cascade. It typically presents with a triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure secondary to thrombotic microangiopathy. Eculizumab, a monoclonal antibody against C5, is the mainstay in the treatment of aHUS and its introduction has made prevention of ESRD a possibility. However, some patients do develop ESRD despite the treatment and require chronic renal replacement therapy (RRT). Although Eculizumab is known to increase susceptibility to meningococcal infections, case reports of intraabdominal fungal infection while being treated with eculizumab have been rare.

Case Description

We present a case of Candida albicans fungal peritonitis within 24 hours of a fluoroscopically placed peritoneal dialysis catheter in an ESRD patient maintained on Eculizumab for aHUS. The patient was given surgical prophylaxis for bacterial pathogens, but not for fungal pathogens prior to the PD catheter placement. Patient clinically improved after removal of PD catheter and was treated with IV then oral fluconazole.


Perhaps surgical prophylaxis for bacterial and fungal pathogens is indicated in patients undergoing PD catheter placement who are treated with eculizumab.