CRYPTOCOCCAL PERITONITIS IN PERITONEAL-DIALYSIS PATIENTS - A CASE-REPORT

Peritonitis in patients on chronic peritoneal dialysis remains a major problem. Most commonly this is due to bacterial infection, but fungal peritonitis is also a treatment dilemma. Peritonitis due to Cryptococ cus neoformans is an unusual event, with fewer than ten cases reported . This case report documents a case of cryptococcal peritonitis in a d iabetic man on prednisone and azathioprine for suspected chronic infla mmatory demyelinating polyneuropathy. The organism was also cultured i n the cerebrospinal fluid and urine and high cryptococcal antigen tite rs were found in the blood indicating systemic infection. The peritone al catheter was removed, immunosuppression was withdrawn and he was tr eated with systemic antifungal therapy He died suddenly nine weeks fol lowing the diagnosis and at Post mortem was found to have evidence of cryptococcosis in lung, spleen and brain. The case demonstrates that c ryptococcal peritonitis in patients on peritoneal dialysis should prom pt a search for systemic infection and may require prolonged therapy.