Habuka Masato, Matsunaga Kosuke, Ogawa Asa, Yaguchi Takashi, Yamamoto Suguru, Tanabe Yoshinari
Division of Nephrology, Niigata Prefectural Shibata Hospital, 1-2-8 Honcho, Shibata, Niigata, 957-8588, Japan.
Medical Mycology Research Center, Chiba University, Chiba, Japan.
CEN Case Rep. 2024 Dec 15. doi: 10.1007/s13730-024-00958-z.
Peritoneal dialysis (PD)-associated peritonitis remains a serious and life-threatening complication in patients undergoing PD. Majority of peritonitis cases are caused by bacteria, with coagulase-negative Staphylococcus being the most common cause. Tsukamurella species are obligate aerobic gram-positive bacilli found in various environments; however, peritonitis caused by Tsukamurella species in association with PD is rare, with few reports of infections caused by T. conjunctivitidis, including PD-associated peritonitis. We describe a rare case of peritonitis caused by T. conjunctivitidis in a patient undergoing PD. A 62-year-old man undergoing PD was referred to our hospital for fever and abdominal pain lasting for 4 days and was diagnosed with PD-associated peritonitis based on abdominal pain, cloudy effluent, elevated white blood cell count in the peritoneal fluid, and presence of gram-positive rods in the effluent culture. Yellow-grayish, dry, membrane-like colonies were observed on a blood agar plate. The isolated strain was identified as T. conjunctivitidis through 16S rRNA gene sequencing. Because the PD-associated peritonitis was refractory to antibiotics, the PD catheter was removed, and the patient was switched to hemodialysis on day 21 of admission. Clinicians should consider peritonitis caused by T. conjunctivitidis as a differential diagnosis in cases where diagnosis using routine examination is challenging. Notably, 16S rRNA gene sequencing is a useful diagnostic tool for identifying T. conjunctivitidis. Further analyses of similar cases are required to understand the characteristics of such infections and establish adequate diagnostic methods and treatment regimens.
腹膜透析（PD）相关腹膜炎仍是接受PD治疗患者的一种严重且危及生命的并发症。大多数腹膜炎病例由细菌引起，凝固酶阴性葡萄球菌是最常见的病因。冢村菌属是在各种环境中发现的需氧革兰氏阳性杆菌；然而，冢村菌属引起的与PD相关的腹膜炎很罕见，关于结膜冢村菌引起感染的报道很少，包括与PD相关的腹膜炎。我们描述了一例结膜冢村菌引起的PD患者腹膜炎罕见病例。一名接受PD治疗的62岁男性因发热和腹痛持续4天被转诊至我院，根据腹痛、腹水浑浊、腹腔液白细胞计数升高以及腹水培养中存在革兰氏阳性杆菌，被诊断为PD相关腹膜炎。在血琼脂平板上观察到黄灰色、干燥、膜状菌落。通过16S rRNA基因测序将分离菌株鉴定为结膜冢村菌。由于该PD相关腹膜炎对抗生素难治，在入院第21天拔除了PD导管，患者改为血液透析。在常规检查诊断具有挑战性的病例中，临床医生应将结膜冢村菌引起的腹膜炎作为鉴别诊断考虑。值得注意的是，16S rRNA基因测序是鉴定结膜冢村菌的有用诊断工具。需要对类似病例进行进一步分析，以了解此类感染的特征并建立适当的诊断方法和治疗方案。
