Aspergillus terreus Peritonitis in a Child on Continuous Ambulatory Peritoneal Dialysis: A Case Report from Pakistan

Abstract

Background: Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). Several cases of fungal peritonitis (FP) caused by Aspergillus species have been reported worldwide; however, there is a paucity of data from Pakistan. Here, a case of congenital nephrotic syndrome is reported in a patient who progressed to Stage 5 chronic kidney disease when she was 8 years old, which was managed by CAPD and other supportive therapies. The patient developed FP and later succumbed to death despite appropriate management. Early diagnosis and careful interpretation of culture results are, therefore, important for the treatment of these patients. Case presentation: The patient outlined in this case report had congenital nephrotic syndrome, Stage 5 chronic kidney disease, and was on CAPD. She presented with peritonitis. Initially, broad spectrum antibiotics were started, and peritoneal samples did not yield any growth. Later, consecutive peritoneal samples taken from the patient grew Aspergillus terreus, with septate hyphae seen on a direct smear from the sample. Voriconazole was started immediately, and the patients’ catheter was removed. However, the patient’s condition deteriorated and, after prolonged intensive care and high ventilator support, the patient expired. Conclusion: A. terreus is an uncommon and deadly pathogen that does not respond to the commonly used antifungal treatments such as amphotericin B. The treatment of CAPD-related FP requires early diagnosis and the use of newer drugs such as voriconazole or caspofungin.