지속성외래복막투석환자에서 발생한 Aspergillus terreus 복막염 1예

Abstract

Aspergillus peritonitis is rare in CAPD patients and is associated with high mortality. We report a case of CAPD peritonitis due to A. terreus successfully treated with a combination of fluconazole therapy and peritoneal catheter removal. The patient, a 53 year-old male on CAPD for 5 months, had sudden onset of diffuse abdominal pain and cloudy effluent. He was initially treated with intraperitoneal cefuroxime and netilmicin. Four days later, there was no improvement of his symptoms, and the patients was admitted to the hospital. On the surface of the inner lumen of the peritoneal catheter, numerous small visible colonies were found. Dialysate samples showed evidence of positive fungal mycelia and spores in the KOH mount. The catheter was removed immediately, and fluconazole was intravenously begun and continued orally for 3 weeks. All samples of dialysate and catheter tip grew A. terreus. Peritonitis symptoms and signs were improved gradually after peritoneal catheter removal and fluconazole therapy. Early peritoneal catheter removal and antifungal therapy may be most important in treatment of dialysis-related Aspergillus peritonitis. The possibility of a pathogenic A. terreus infection should be considered in CAPD peritonitis patients.