Abstract: FR-PO483
An Uncommon Cause of Peritonitis in a Peritoneal Dialysis Patient
Session Information
- Peritoneal Dialysis: Current Topics
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Carias Martinez, Karla G., Johns Hopkins Medicine, Baltimore, Maryland, United States
- Patel, Dipal, Johns Hopkins Medicine, Baltimore, Maryland, United States
Introduction
Peritonitis is a common complication of peritoneal dialysis (PD), associated with significant morbidity and mortality, catheter loss and transfer to hemodialysis. It is caused mostly by gram-positive organisms. Neisseria species have been rarely reported as a causative agent.
Case Description
28-year-old female with ESKD secondary to FSGS on automated PD presented with abdominal pain and cloudy dialysis effluent after sustaining a motor vehicle accident 2 days prior. She was hemodynamically stable with marked midline abdominal pain. Her PD catheter exit site and tunnel were clean and without evidence of inflammation or trauma, but she was noted to have milky white fluid in her catheter tubing. Labs were significant for leukocytosis of 27.5K/mm3, hemoglobin 10.4 g/dL, and lipase 15 U/L. Abdominal imaging was negative for pancreatitis, drainable fluid collections, or free air and her PD catheter was appropriately positioned. PD effluent analysis (Table 1) revealed leukocytosis with neutrophil predominance and a negative gram stain, with effluent amylase 8 U/L. Given ongoing suspicion for peritonitis, she was started on empiric antibiotics with IV cefepime, vancomycin, and metronidazole. After 3 days of therapy, effluent studies were repeated with improvement in cell counts (Table 1). Her effluent culture later grew Neisseria gonorrhea, after which antibiotics were narrowed to ceftriaxone to complete 14 days of treatment. Several months post-treatment, she has not had a recurrence of peritonitis and continues to perform PD successfully without significant change in her transport characteristics. Though she denied breaks in sterile technique , she did mention a preceding episode of unprotected intercourse.
Discussion
Neisseria gonorrhea is a gram-negative pathogenic microorganism that has rarely been isolated as a cause of peritonitis in patients in PD. Prior to our report, there has been only one other case report in which the patient also effectively responded to IP antibiotic therapy. Neisseria gonorrhea should be considered as a possible causative agent of peritonitis in young sexually active patients performing PD.