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Open Access Highly Accessed Case report

Mycobacterium fortuitum as a cause of peritoneal dialysis-associated peritonitis: case report and review of the literature

Simon H Jiang1, Darren M Roberts12*, Andrew H Dawson3 and Meg Jardine14

Author Affiliations

1 Department of Renal Medicine, Concord Repatriation and General Hospital, Concord, New South Wales, Australia

2 School of Medicine, University of Queensland, Herston, Queensland, Australia

3 School of Medicine, University of Western Sydney, Penrith, New South Wales, Australia

4 Renal & Metabolic Division, The George Institute for Global Health, Camperdown, New South Wales, Australia

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BMC Nephrology 2012, 13:35  doi:10.1186/1471-2369-13-35

Published: 8 June 2012

Abstract

Background

Peritoneal dialysis-associated peritonitis (PD-peritonitis) due to Mycobacterium spp is uncommon. Non-tuberculous Mycobacterium (NTB) PD-peritonitis can present in a similar fashion to more common causes of bacterial PD-peritonitis. We describe the first reported case of multiresistant Mycobacterium fortuitum PD-peritonitis in an Australian patient.

Case presentation

A 38 year-old woman developed mild PD-peritonitis during an overseas holiday. Treatment was complicated by delayed diagnosis, requirement for special investigations, treatment with multiple antibiotics, and conversion to haemodialysis following removal of her Tenckhoff catheter.

Conclusion

This case demonstrates the diagnostic yield of pursuing further investigations in cases of initially culture-negative, problematic PD-peritonitis. A systematic review of the literature identified only 17 reports of M. fortuitum PD-peritonitis. Similar to our case, a delay in microbiological diagnosis was frequently noted and the Tenckhoff catheter was commonly removed at the time of diagnosis. The type and duration of antibiotic therapy also varied widely so the optimum treatment appears to be poorly defined.

Keywords:
Mycobacterium fortuitum; Peritoneal dialysis; Peritonitis; Treatment