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Abstract: FR-PO565

An Unusual Presentation of an Unusual Disease: Cryptococcus Neoformans Peritonitis in a Patient on Peritoneal Dialysis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Moreno, Rodolfo Alejandro, Hospital Civil de Guadalajara, Guadalajara, Mexico
  • Font, Jorge Jaime, Hospital civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
  • Maggiani, Pablo, Hospital civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
  • Muñoz-Garibi, Fernanda, Universidad de Guadalajara, Guadalajara, Mexico
  • Esquivel razo, Silvia Guadalupe, Hospital Civil Fray Antonio Alcalde, Zapopan, Mexico
  • Magana-Gonzalez, Rafael, Universidad de Guadalajara, Guadalajara, Mexico
  • Ramirez-Gonzalez, Aida Sarai, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
  • Garcia, Pablo, Stanford University, Palo Alto, California, United States
  • Chavez, Jonathan, Hospital Civil de Guadalajara, Guadalajara, Mexico
  • Garcia-Garcia, Guillermo, Hospital Civil De Guadalajara, University of Guadalajara, Zapopan, jalisco, Mexico
Introduction

Mexico is the country with more peritoneal dialysis (PD) patients in the world, and it’s used by the majority of the patients requiring RRT. Cryptococcus neoformans is an opportunistic infection in the immunocompromised population. The central nervous system is the most common organ affected. Peritonitis is an unusual complication of infections caused by C. neoformans and has rarely been reported in patients on PD. We present a case of peritonitis due to C. neoformans in a patient on PD in Mexico.

Case Description

A 36-year old Mexican female came to the ED with headaches and photophobia for about one week. These symptoms were associated with weight loss (60 pounds), for about 5 months. The patient had ESKD secondary to DM. She lived in a rural area located in the central western coast of Mexico. She owned chickens, cats, and dogs. She reported three sexual partners with no condom use. On admission, she had fever, photophobia, bilateral Babinski, hyperreflexia of upper and lower extremities and nuchal rigidity. The initial labs didn’t reveal significant abnormalities; except for a positive-HIV test. We performed a lumbar puncture (LP) and also obtained PD fluid samples. Both were positive for C. neoformans. We started therapy with liposomal amphotericin B (6mg/kg/day) and fluconazole; the nephrology team removed the PD catheter, and transitioned her to HD. Her hospital course was complicated with hospital-associated infections, and despite all efforts, the patient died after 20 days of therapy.

Discussion

To our knowledge there are around 4 cases of C. neoformans’s peritonitis associated to PD since 1988 when the first case was reported. The previously case presented is the first one reported in Mexico and Latin America. The reported cases had a predominance of female gender and comorbidities such as HIV infection, hypertension, DM and 25% had fatal outcome. C. neoformans is a deadly and underdiagnosed pathology worldwide. The diagnosis can often be challenging in areas with limited access to healthcare, and thus, the treatment is delayed. The determination of peritonitis by C. neoformans must be considered in patients on PD and must lead to the suspicion of a disseminated infection.