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Abstract: PO1007

A Rare Case of Roseomonas gilardii Peritonitis in a Peritoneal Dialysis Patient

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Ediale, Temi-Ete I., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Karandish, Saeid, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Imam, Ayesha Mallick, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Stern, Aaron S., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Linden, Ellena A., Icahn School of Medicine at Mount Sinai, New York, New York, United States
Introduction

We report a case of Roseomonas gilardii peritonitis in a continuous ambulatory peritoneal dialysis patient.

Case Description

A 71-year-old woman with end stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) for 5 years presented with cloudy effluent without abdominal pain or fever. Laboratory studies revealed a fluid cell count of 800 wbcs/mm3 with 87% neutrophils. She was started on empiric antibiotic therapy with intraperitoneal vancomycin and ceftazadime. Effluent remained cloudy with elevated WBC despite a 2-week course of antibiotics. Eventually culture grew Roseomonas gilardii, a slow growing gram-negative bacillus sensitive to aminoglycosides. Her antibiotic was changed to IP gentamycin and her effluent cleared by day three. Gentamycin was continued for three weeks to ensure she didn’t have a relapse as per prior described experience in a similar case.

Discussion

Peritoneal dialysis peritonitis is known to be caused mainly by gram positive and occasionally gram-negative organisms, the usual culprits being pseudomonas, Klebsiella etc. Roseomonas has recently been implicated as a rare cause of bacterial peritonitis with only six reports between 1997 till date. It was first described in 1993 as a cause of bacteremia in humans.
Roseomonas gilardii is a pink-pigmented, oxidized, gram-negative coccobacillus genus of Roseomonas associated with contaminated water source and soil. Our patient was unaware of being in contact with contaminated water or soil however this could not be ruled out as she did endorse having plants. Of the six cases reported, ours is the third case of R. gilardii reported till date.
Although the incidence of peritoneal dialysis peritonitis caused by Roseomonas gilardii is rare, it is causative agent to be considered by physicians and laboratory staff in the differential diagnosis of refractory bacterial peritonitis in peritoneal dialysis patients. It also serves as a point to emphasize when educating PD patients on the hand-washing techniques and ensuring sterility of water source used for this.