Fatal peritoneal dialysis-associated peritonitis caused by Mycobacterium mageritense: a case report with review

• Published in: Renal replacement therapy Vol. 9; no. 1; p. 5
• Main Authors: Hashimoto, Nobuhiro, Kani, Nao, Makino, Shuzo, Naka, Tomoya, Miyakawa, Hiromitsu, Okamoto, Kazuhiro, Uwatoko, Ryuta, Bessho, Saki, Iio, Rei, Ueda, Yoshiyasu, Hayashi, Terumasa
• Format: Journal Article
• Language: English
• Published: London Springer Nature B.V 16.01.2023; BMC
• Subjects: Abdomen; Antibiotics; Bacterial infections; Blood; Body temperature; Cardiovascular disease; Case reports; Catheters; Chronic obstructive pulmonary disease; Drugs; Effluents; Exocrine glands; Kidney diseases; Laboratories; Mortality; Mycobacterium mageritense; Neutrophils; Nontuberculous mycobacteria (NTM); Peritoneal dialysis; Peritonitis; Prostheses; Proteins; Staphylococcus infections; Surgery; Tomography; Tuberculosis; Viral infections
• ISSN: 2059-1381; 2059-1381
• DOI: 10.1186/s41100-023-00457-4

Abstract Background Peritonitis is a serious and potentially fatal complication of peritoneal dialysis. We report a case of fatal peritonitis caused by Mycobacterium mageritense that was detected for the first time in peritonitis. Case presentation A male patient in his 60 s undergoing peritoneal dialysis was admitted for catheter diversion with exit-site renewal. The patient had a refractory exit-site infection. Mycobacterial culture was not performed at the exit site prior to admission. After the surgery, the patient developed a fever, and a cloudy effluent was observed. Various antibiotics, including anti-tuberculosis drugs, were administered; however, his symptoms did not improve. The catheter was removed on the thirty-seventh day of admission. Bacteria positive for Ziehl–Neelsen staining were found in the peritoneal sample collected during the surgery. Since nontuberculous mycobacteria were considered the cause of peritonitis, the patient was administered imipenem/cilastatin, amikacin, and clarithromycin. However, he died of septic shock on the fifty-first day after admission. Mycobacterium mageritense was detected in the ascites culture after death. Conclusion This is, to our knowledge, the first report of peritonitis caused by Mycobacterium mageritense . In patients undergoing peritoneal dialysis, when a refractory exit-site infection is observed, mycobacterial culture is necessary to prevent the development of peritonitis.