Trichosporon beigelii peritonitis in a CAPD patient: a case report

A 60-year-old man with endstage chronic renal failure due to diabetic nephropathy had been treated with CAPD since November 1997. He had been admitted to our hospital 6 times because of recurrent bacterial peritonitis. Each episode responded to antibiotic treatment. On June 23, 2001, he was admitted to our hospital because of abdominal pain and cloudy dialysate. In this case, Trichosporon beigelii (T. beigelii) proved to be the pathogen causing peritonitis by culture of CAPD fluid. He was initially treated with intravenous fluconazole, but fever, abdominal pain and inflammatory signs persisted. On the 18th hospital day, the CAPD catheter was removed and hemodialysis was initiated. Ultrasonography and computerized tomography of the abdomen demonstrated subphrenic fluid collection, which were treated with drainage. Based on antifungal susceptibility testing, miconazole was administrated. Thereafter, the symptoms disappeared. There is only one previous case report of T. beigelii peritonitis in CAPD in Japan. In that case, recurrent bacterial peritonitis and recent antibiotic therapy preceded T. beigelii infection. Removal of the CAPD catheter and drainage facilitated effective therapy.