SHM Converge Scientific Abstract ePoster Gallery-Something in the Water: Curious Case of Peritoneal Dialysis-Associated Peritonitis

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This case report describes a 43-year-old man on peritoneal dialysis (PD) who developed refractory peritonitis caused by <strong>Mycobacterium chelonae</strong>, a rare non-tuberculous mycobacterium (NTM). Although most PD-associated peritonitis cases are due to skin flora, clinicians should consider atypical organisms when symptoms do not improve with standard empiric antibiotics.

The patient presented with nausea, vomiting, abdominal pain, and cloudy dialysate. He had a history of end-stage renal disease from type 1 diabetes and two prior episodes of PD-associated peritonitis. Despite outpatient treatment with intraperitoneal vancomycin and ceftazidime, his symptoms worsened. On admission, he was afebrile but tachycardic and hypertensive, with leukocytosis and a highly inflammatory peritoneal fluid profile. Initial gram stain showed no organisms, and he was started on IV cefepime and vancomycin. Because symptoms persisted, the PD catheter was removed and hemodialysis was initiated.

Four days later, the dialysate culture grew <strong>M. chelonae</strong>. Antibiotics were changed to oral azithromycin, moxifloxacin, and linezolid, leading to rapid clinical improvement. He was discharged on an 8-week oral regimen.

The report emphasizes that NTM peritonitis is uncommon, can appear indistinguishable from typical bacterial peritonitis, and is often associated with poor outcomes and delayed diagnosis. Potential reservoirs include natural environments and water supplies; in this patient, well water was suspected as the source. The authors conclude that NTM should be suspected in PD patients with refractory symptoms or culture-negative peritonitis, and management should include catheter removal plus targeted antimicrobial therapy.

Asset Subtitle

Roshini Srinivasan

Meta Tag

Author List Aubrey Jolly Graham, Joanna Schneider Cavalier, Roshini Srinivasan

Category Clinical Vignettes

Concept Peritoneal Dialysis-Associated Peritonitis

Concept Nontuberculous mycobacteria

Concept Peritoneal Dialysis Catheter Removal

Concept Skin Flora

Concept Culture-Negative Peritonitis

Distinguished Non-Finalist

Presenter Organization Duke University School of Medicine

Presenting Author Roshini Srinivasan

Track Adult

Keywords

peritoneal dialysis

refractory peritonitis

Mycobacterium chelonae

non-tuberculous mycobacteria

PD catheter removal

culture-negative peritonitis

end-stage renal disease

intraperitoneal antibiotics

azithromycin

hemodialysis

Peritoneal Dialysis-Associated Peritonitis

Nontuberculous mycobacteria

Peritoneal Dialysis Catheter Removal

Skin Flora

Culture-Negative Peritonitis