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Critical peritonitis secondary to gastrointestinal mucormycosis in a peritoneal dialysis patient: a case report

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Abstract

Immunodeficient patients are susceptible to systemic fungal infections; however, these rarely cause secondary peritonitis. A 66-year-old man with multiple myeloma and diabetes mellitus on continuous ambulatory peritoneal dialysis (CAPD) presented with cloudy ascitic fluid. He had been treated with corticosteroids for 1 month for Tolosa–Hunt syndrome. We diagnosed peritoneal dialysis-related peritonitis caused by Enterococcus avium, removed the CAPD catheter, and initiated intravenous ampicillin. Computed tomography (CT) revealed an intramural gastric mass and a thinning ascending colon wall. Four days later, follow-up contrast-enhanced CT showed penetration of the ascending colon and rupture of the ileocolic artery. Emergency open surgery revealed hemorrhagic infarction with mucormycosis. We initiated intravenous liposomal amphotericin B 20 days after admission; however, he died 55 days later. Anatomical abnormalities, such as gastrointestinal perforation, should be considered for peritonitis in immunodeficient patients. Gastrointestinal mucormycosis is rare but fatal, resulting from a delay in diagnosis and consequent gastrointestinal perforation. For an early diagnosis and a favorable clinical outcome, it is important to consider the risk factors for mucormycosis, including corticosteroid use, diabetes, end-stage kidney diseases.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Nephrology, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan

    Soken Hattori, Makoto Hirakawa, Yusuke Nakamata, Kazuhiro Okamura, Tomoya Hamashoji, Takuro Kometani, Takafumi Nakashima & Sho Sasaki

  2. Department of Infectious Diseases, Aso Iizuka Hospital, Iizuka, Japan

    Takashi Matono

  3. Department of Surgery, Aso Iizuka Hospital, Iizuka, Japan

    Ryosuke Minagawa & Kiyoshi Kajiyama

Authors
  1. Soken Hattori
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  2. Takashi Matono
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  3. Makoto Hirakawa
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  4. Yusuke Nakamata
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  5. Kazuhiro Okamura
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  6. Tomoya Hamashoji
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  8. Takafumi Nakashima
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  10. Ryosuke Minagawa
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Correspondence to Soken Hattori.

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All the authors have declared no competing interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number C20094 at the Aso Iizuka Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hattori, S., Matono, T., Hirakawa, M. et al. Critical peritonitis secondary to gastrointestinal mucormycosis in a peritoneal dialysis patient: a case report. CEN Case Rep 11, 31–35 (2022). https://doi.org/10.1007/s13730-021-00628-4

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  • DOI: https://doi.org/10.1007/s13730-021-00628-4

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