SHM Converge Scientific Abstract ePoster Gallery-A Not-So Fortuitous Case of Mycobacterium

Pdf Summary

This case describes a 66-year-old man with ESRD on home peritoneal dialysis who developed abdominal pain, distension, fever, and altered mental status after accidentally removing his PD catheter. Initial evaluation suggested peritonitis, and he was started on empiric cefepime and vancomycin. Although blood cultures were negative, repeat peritoneal fluid culture grew acid-fast bacilli, later identified as <strong>Mycobacterium fortuitum</strong>, a rare nontuberculous mycobacterium found in soil and water.

The diagnosis was challenging because M. fortuitum can be slow to grow and may appear culture-negative early in the course. The report emphasizes the importance of <strong>acid-fast staining</strong> and <strong>prolonged culture observation</strong> to avoid delayed recognition. Once identified, the patient improved after treatment was changed to imipenem, levofloxacin, and TMP-SMX. Because M. fortuitum can infect tunneled lines and cause persistent infection, his PD catheter was removed and he was transitioned to hemodialysis.

He received 8 weeks of inpatient antibiotics and was discharged on 6 additional months of oral linezolid, levofloxacin, and azithromycin. The case highlights that ESRD patients are at increased risk for mycobacterial infection and that M. fortuitum should be considered in <strong>refractory or culture-negative peritonitis</strong>. Early diagnosis, catheter removal, and prolonged multidrug therapy are key to successful treatment and preventing complications.

Asset Subtitle

Evan Raff

Meta Tag

Author List Christopher A. Caulfield, Evan Raff, Hannah Pollock, Lara Phipps, Meg Johnson, Rachel Lile-King

Category Clinical Vignettes

Concept Mycobacterium fortuitum

Concept Peritonitis

Concept Peritoneal Fluid Culture

Concept Catheter Removal

Concept End-stage Kidney Disease

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

Mycobacterium fortuitum

peritonitis

peritoneal dialysis

ESRD

acid-fast bacilli

nontuberculous mycobacteria

catheter removal

culture-negative infection

multidrug therapy

hemodialysis

Mycobacterium fortuitum

Peritonitis

Peritoneal Fluid Culture

Catheter Removal

End-stage Kidney Disease