Somtha Baramett, Tianprasertkij Kanjana, Promngam Supattra, Saejew Thunvarat, Kanjanabuch Talerngsak
Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Dialysis Unit, Sakaeo Crown Prince Hospital, Sakaeo, Thailand.
Med Mycol Case Rep. 2025 Feb 11;47:100697. doi: 10.1016/j.mmcr.2025.100697. eCollection 2025 Mar.
Fungal peritonitis in peritoneal dialysis (PD) presents significant challenges. We report the second -related PD peritonitis in a 53-year-old male. Negative bacterial cultures and a positive galactomannan (GM) index in both PD effluent (PDE) (0.65) and serum (0.98) prompted early PD catheter removal on day 5. Molecular sequencing confirmed , with antifungal susceptibility testing revealing resistance to azoles and echinocandins but susceptibility to amphotericin B and isavuconazonium. Treatment with amphotericin B and voriconazole resolved symptoms, with no relapses during a two-year follow-up. This case highlights GM testing's critical role in guiding catheter removal and adherence to the 2022 ISPD Peritonitis Guidelines, ensuring favorable outcomes for rare fungal PD infections.
腹膜透析（PD）中的真菌性腹膜炎带来了重大挑战。我们报告了一名53岁男性患者发生的第二例与腹膜透析相关的腹膜炎。细菌培养结果为阴性，而腹膜透析流出液（PDE）（0.65）和血清（0.98）中的半乳甘露聚糖（GM）指数均为阳性，这促使在第5天早期拔除腹膜透析导管。分子测序得到确认，抗真菌药敏试验显示对唑类和棘白菌素耐药，但对两性霉素B和艾沙康唑敏感。两性霉素B和伏立康唑治疗使症状得到缓解，在两年的随访期间无复发。该病例突出了GM检测在指导导管拔除及遵循2022年国际腹膜透析学会（ISPD）腹膜炎指南方面的关键作用，确保罕见真菌性腹膜透析感染获得良好预后。
