Kidney Week

Abstract: FR-PO483

A Case of Rare Polymicrobial Quadruple Zoonotic Peritonitis in a Patient on Continuous Cycling PeritonealDialysis (CCPD)

Session Information

• Home Dialysis - 1
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Wang, Ao, SUNY Downstate Health Sciences University, New York City, New York, United States

Ao Wang, MD

• Gomberg, Gilana, Mount Sinai Health System, New York, New York, United States

Gilana Gomberg, MD

• Sharma, Shuchita, Mount Sinai Health System, New York, New York, United States

Shuchita Sharma, MD

• Uribarri, Jaime, Mount Sinai Health System, New York, New York, United States

Jaime Uribarri, MD

Introduction

Polymicrobial peritonitis is associated with higher hospitalization, catheter removal, permanent HD transfer and death than monomicrobial peritonitis. Zoonotic peritonitis is rare with a reported prevalence of only 0.54% of all peritonitis episodes [1]. We present a case of polymicrobial peritonitis caused by four zoonotic organisms including Neisseria Shayeganii, to our knowledge, this is the first case ever reported of PD-peritonitis associated with Neisseria Shayeganii.

Case Description

A 57-year-old male with ESRD on CCPD for 4 years presented to our PD clinic with mild abdominal pain and cloudy peritoneal effluent. Past medical history was relevant for kidney disease due to MGN status post cyclophosphamide and steroids and prostate cancer status post-prostatectomy. Social history was relevant for owning a cat and a dog.

Physical exam was remarkable only for tachycardia and hypotension. Peritoneal effluent analysis showed 774 WBC/uL with 69% neutrophils and culture was sent. He was empirically treated with IP vancomycin and gentamicin for peritonitis. His abdominal pain resolved, peritoneal effluent became clear and showed down trending WBC from 774/uL to 25/uL with 58% neutrophil with no growth on cultures after 3 days.

One week later, he again presented with abdominal pain and tenderness with nausea, vomiting and diarrhea and found to be tachycardic and hypotensive. He was admitted to the hospital for sepsis. PD effluent analysis showed 26,460 WBC/uL with 78% neutrophils and gram-negative bacilli and gram-positive rods on gram stain. PD culture from first clinic visit had very slow growth and eventually turned out to be positive for Neisseria shayeganii, Paenibacillus glucanolyticuls/lantus, Cutibacterium(propionibacterium) acnes and Capnocytophaga species. He received IP vancomycin, oral ciprofloxacin, fluconazole and later switched to IV piperacillin-tazobactam for 7 days. His symptoms improved and he was discharged with amoxicillin and clavulanate for 3 weeks. However, he continued to have elevated WBC with predominantly neutrophils in PD effluent. Decision was made to remove PD catheter and transfer to HD.

Discussion

We presented an uncommon case of PD related peritonitis with polymicrobial rare zoonotic organisms. We believe this case can help enhance clinician awareness and understanding of Neisseria Shayeganii and other zoonotic-related peritonitis.