Fungal peritonitis with splenic-pelvic abscess in a patient on continuous ambulatory peritoneal dialysis
Urizar, R.E.; Lepow, M.; Neumann, M.; Pietrocola, D.; Sarrafizadeh, M.
Peritoneal Dialysis International Journal of the International Society for Peritoneal Dialysis 13(2): 162-163
1993
ISSN/ISBN: 0896-8608 PMID: 8494942 Document Number: 407786
A case is reported in an 18-yr-old female patient on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis due to Candida parapsilosis. Haemodialysis was substituted and intravenous amphotericin B (0.5 mg/kg daily) was administered for 2 wk with good clinical results. CAPD with a new catheter was resumed, but yeast infection of the peritoneal fluid persisted and fever, abdominal discomfort and progressive anaemia developed. Abdominal ultrasound and computed tomography (CT) demonstrated an abscess extending from the splenic area to the pelvis. Percutaneous drainage produced serosanguinous-purulent material and microscopic examination revealed yeasts, although fungal cultures were negative. After a repeat course of amphotericin B (0.8 mg/kg daily), CT scan revealed a persistent abscess around and in the spleen. The patient received weekly systemic amphotericin B, fluconazole (100 mg/d), vancomycin and oral mycostatin, and a partially necrotic spleen was surgically removed. The patient recovered with no recurrence of infection in 6 months of follow-up.