Open AccessCritical peritonitis secondary to gastrointestinal mucormycosis in a peritoneal dialysis patient: a case report
Author(s) -
Soken Hattori,
Takashi Matono,
Makoto Hirakawa,
Yusuke Nakamata,
Kazuhiro Okamura,
Tomoya Hamashoji,
Takuro Kometani,
Tsunehiko Nakashima,
Shin Sasaki,
Ryosuke Minagawa,
Kiyoshi Kawakami
Publication year - 2021
Publication title -
cen case reports
Language(s) - English
Resource type - Journals
ISSN - 2192-4449
DOI - 10.1007/s13730-021-00628-4
Subject(s) - medicine , mucormycosis , peritonitis , perforation , surgery , continuous ambulatory peritoneal dialysis , peritoneal dialysis , gastroenterology , materials science , punching , metallurgy
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.