PERITONEAL-DIALYSIS COMPLICATED BY BIPOLARIS-HAWAIIENSIS PERITONITIS - SUCCESSFUL THERAPY WITH CATHETER REMOVAL AND ORAL ITRACONAZOL WITHOUT THE USE OF AMPHOTERICIN-B

Fungi classified in the genera Bipolaris are an uncommon source of inf ection in human diseases. It is also a rare source of peritonitis in p eritoneal dialysis (PD) patients. All cases of Bipolaris peritonitis r eported in the United States have occurred in the southern states. Thi s form of peritonitis appears to have a good prognosis, with cure achi eved only after removal of the peritoneal dialysis catheter and antifu ngal therapy, Systemic or intraperitoneal amphotericin-B with or witho ut oral ketoconazole has been used in all previously reported cases. H owever, the role of antifungal therapy is unclear, We report a case of Bipolaris hawaiiensis peritonitis in a 73-year-old female on continuo us cyclic peritoneal dialysis (CCPD) for 10 months who presented with a nonfunctioning peritoneal catheter, The catheter had characteristic dark gray particles, each composing a fungal ball within the lumen of the catheter. Microscopic examination confirmed the organism attached to the inner wall of the catheter. The patient achieved cure without u sing either amphotericin-B or ketoconazole, She was treated with remov al of the catheter and a 2-week course of oral itraconazole 100 mg twi ce daily, A new catheter was placed after 1 month and the patient cont inued to do well on CCPD 12 months later with no evidence of recurrent infection. We conclude that (1) itraconazole can effect cure followin g removal of the catheter without using amphotericin-B or ketoconazole ; (2) peritoneal dialysis can be safely reinstituted after itraconazol e therapy for this uncommon fungal infection, and (3) itraconazole the rapy allows for out-patient treatment of B. hawaiiensis peritonitis in peritoneal dialysis patients,