Peritoneal dialysis-associated peritonitis due to infected umbilicus

Abstract

We provide the first case report of peritoneal dialysis (PD)-associated peritonitis due to Lasiodiplodia theobromae, a known plant pathogen causing rotting and dieback in post-harvest citrus fruit, in immunocompetent patient with fungal colonization inside the PD catheter lumen. A root cause analysis suspected the patient's umbilical infection as the source of contamination. The fungal infection was established through microscopic examination of the PD catheter lumen and galactomannan testing in both serum and effluent. The species of pathogen was confirmed by DNA barcoding. The patient responded well to timely PD catheter removal and a 2-week course of oral voriconazole. Preventive strategies should prioritize hygiene practices, including umbilical care, to mitigate the risk of contamination and subsequent infections of fungal pathogens.

Keywords: Fungal peritonitis; Lasiodiplodia theobromae peritoneal dialysis; Peritonitis; Tinea corporis; Umbilicus.

Fig. 1

Black colonization was observed inside the PD catheter lumen (A); Direct microscopic examination with a 20 % potassium hydroxide (KOH) mount from the catheter revealed dark-brown branching septate hyphae (B). Lasiodiplodia theobromae colonies grown on Sabouraud dextrose agar (Oxoid, Hampshire, UK) on day 3 (C) exhibiting a long, dark septate hyphae when viewed under lactophenol cotton blue mounting (D). The infected umbilicus demonstrated well-demarcated erythematous lesion and scaling (E). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)