Spontaneous fungal peritonitis (Candida glabrata) in a patient with cirrhosis

We report a case of spontaneous fungal peritonitis in a patient with cirrho sis. A 70-year-old woman with cirrhosis secondary to autoimmune hepatitis w as admitted with fever and abdominal distention. Paracentesis revealed neut rocytosis, and despite appropriate antibacterial coverage, no clinical impr ovement was noted and the ascitic fluid white cell count increased on repea t paracentesis. Two consecutive ascitic fluid cultures grew Candida glabrat a, and antifungal therapy with amphotericin was initiated, pending sensitiv ity of the isolate. Because of worsening renal function, amphotericin was d iscontinued and itraconazole was started, as sensitivity of the isolate was then available. Antifungal therapy resulted in resolution of ascitic fluid neutrocytosis and culture negativity. However, the patient's renal functio n continued to deteriorate, necessitating hemodialysis. Despite multiple co urses of antibiotics, she died of fulminant sepsis and multiorgan failure.