VERTICILLIUM PERITONITIS IN A PATIENT ON PERITONEAL-DIALYSIS

We describe a case of peritonitis due to Verticillium spp. in a 33-yea r-old farmer on continuous ambulatory peritoneal dialysis (CAPD) for 3 months for endstage renal failure due to chronic pyelonephritis. The etiologic agent was a hyaline hyphomycete which we report as a new hum an opportunistic pathogen. The fungus was isolated from the peritoneal fluid culture and from the tip of the catheter; identification was ma de on the basis of macroscopic and microscopic features. The patient h ad previously been admitted to our hospital for peritonitis caused by mixed enteric flora and treated for 8 days with intraperitoneal broad- spectrum antibiotic therapy. Five days after discharge he was readmitt ed for severe abdominal pain and cloudy drainage fluid. Two days of in traperitoneal broad-spectrum antimicrobial therapy produced no clinica l improvement. Intravenous fluconazole and oral flucytosine were admin istered upon identifying the fungus. After another 2 days without impr ovement, peritoneal dialysis was discontinued and the catheter removed . Antimycotic therapy was continued for 4 days with complete resolutio n of the peritonitis. The patient chose to start hemodialysis and was discharged in good clinical condition.