Abstract: PO0978
Recurrent Abdominal Pain in a Patient on Peritoneal Dialysis
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
- Shringi, Sandipan, Saint Vincent Hospital, Worcester, Massachusetts, United States
- Guntupalli, Sri Vibhavari, Saint Vincent Hospital, Worcester, Massachusetts, United States
- Corapi, Kristin M., Saint Vincent Hospital, Worcester, Massachusetts, United States
Introduction
Abdominal pain can have many differentials in patients on peritoneal dialysis (PD). Some of them, including fungal peritonitis, requires PD catheter removal and a change in dialysis modalities. Here we present a case of recurrent abdominal pain in a patient on peritoneal dialysis which highlights the importance of prompt diagnosis.
Case Description
40-year-old female with end stage renal disease secondary to systemic lupus erythematosus on PD for 3 years presented for urgent clinic appointment after her system was disconnected with leakage of PD fluid. PD effluent revealed white count of 300 with 2% neutrophils. She was treated empirically for peritonitis. 11 days later her fungal culture grew Candida famata and she was admitted with intermittent abdominal pain associated with vomiting and weakness. She was hemodynamically stable, and her exam was significant for epigastric tenderness with normal looking PD catheter site. Her white count was elevated to 13,000 with unremarkable metabolic panel. CT abdomen was unremarkable. A repeat PD effluent had white count of 40. Her PD catheter was removed the next day and she was switched to hemodialysis. She was treated with 10 days of oral fluconazole.
On review, she had been having intermittent abdominal pain with PD effluent sometimes showing high white count for which she got multiple antibiotic courses for either presumed or culture positive bacterial peritonitis. She had also grown positive fungal culture about 18 months ago with Candida albicans and Stereum complicatum which went unnoticed.
Discussion
Fungal peritonitis can be catastrophic for patients on PD. Treatment involves prompt catheter removal and systemic antifungal treatment. Given its dire consequences, prevention is paramount. The ISPD recommends using anti-fungal prophylaxis when PD patients receive antibiotic courses. Risk factors include previous bacterial peritonitis and antibiotic use.
This case demonstrates the need to follow cultures as fungal growth is slow and can take weeks. It is important to have a high index of suspicion for a fungal organism when cultures are negative. This patient received antibiotics on several occasions but only developed fungal peritonitis on 2 occasions which raises concern on antifungal prophylaxis. Further studies are indicated to determine number needed to treat to decide on need for antifungal prophylaxis.