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Exophiala Jeanselmei Peritonities in a Patient on Capd

treatment protocol, administration route, and the appropriate time to remove the peritoneal catheter (6-10). We are reporting the clinical aspects and treatment of a rare fungal peritonitis. This is the third case published in the literature, and the first one in which the contamination of the catheter was macroscopically visible. This 57 -year-old woman, with end-stage renal failure secondary to interstitial nephropathy, on CAPD for 40 months, came to the hospital complaining of moderate abdominal pain, located in both iliac fossae, and cloudy peritoneal effluent. She was afebrile. She had no previous peritonitis or infection in the exit site. A week before this presentation, she suffered a respiratory infection and was started on antibiotic treatment ( cefonicide). On examination, she was well and her abdomen was soft, but she had rebound tenderness, especially in the iliac fossae. Interestingly, in the interior of the visible external portion of the peritoneal catheter, and in the transfer tubing, one could observe small plaques approximately 1 mm x 5 mm in size, with a grayish appearance and attached to the interior surface, easily detached by pressure with the fingers, and moving out with the drained fluid. The patient had not noticed the spots before. The white blood cell (WBC) count was 8300/ mm3 [78% were polymorphonuclear leukocytes (PMN)]. Abdominal ultrasound was normal. The dialysate effluent was slightly cloudy, with a WBC count of 340/mm3 (34% was PMN leukocytes, 52% was lymphocytes, and 11% was monocytes). The microbiological exam showed that the macroscopic plaques corresponded to yeast colonies. The patient was treated according to the protocol proposed by Exophiala Jeanselmei Peritonities in a Patient on CAPD