Peritonitis by Exophiala dermatitidis in a pediatric patient

Abstract

Fungal peritonitis is frequent on peritoneal dialysis, with rare cases by Exophiala dermatitidis. A 25-month-old female admitted to the pediatric ICU with acute renal failure was submitted to peritoneal dialysis. After 10 days patient presented fever. Peritoneal fluid culture showed yeast colonies molecularly identified as E. dermatitidis. Patient was treated with voriconazole and hemodialysis. The literature was reviewed. Disseminated infections are frequently fatal, but appropriate diagnose and therapeutic led to cure in this case.

Keywords: Dialysis; Fungal infection; Molecular diagnosis; Phaeohyphomycosis; Therapeutic management.

Fig. 1

Identification of Exophiala dermatitidis strain HC885 isolated from peritoneal fluid. A: Macromorphology showing the greyish to olive colonies; B and C: Micromorphology, presence of yeasts cells and dark septate hyphae with conidia around phialide openings; D: Phylogenetic tree based on confidently aligned rDNA Internal Transcribed Spacer (ITS) sequences constructed with Maximum likelihood implemented in MEGA v.7. Bootstrap values > 80% from 100 resampled datasets are shown with the branches.

Fig. 2

Exophiala dermatitidis human infections. (A): Geographic distribution of reported cases with regional immunological status; (B): percentage of cases related to age-groups, genre and immunological status.