Intractable ascites in a female receiving hemodialysis

Somkanya Tungsanga; Pongpratch Puapatanakul; Athiphat Banjongjit; Jakapat Vanichanan; Kriang Tungsanga; Talerngsak Kanjanabuch

doi:10.1016/j.mmcr.2023.03.006

Intractable ascites in a female receiving hemodialysis

Med Mycol Case Rep. 2023 Mar 28:40:47-49. doi: 10.1016/j.mmcr.2023.03.006. eCollection 2023 Jun.

Authors

Somkanya Tungsanga^{1

2

3}, Pongpratch Puapatanakul^{1

3}, Athiphat Banjongjit⁴, Jakapat Vanichanan⁵, Kriang Tungsanga¹, Talerngsak Kanjanabuch^{1

6

3}

Affiliations

¹ Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
³ Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
⁴ Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Bangkok, Thailand.
⁵ Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁶ Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Thailand.

Abstract

We report a case of a 60-year-old female who presented with intractable ascites 2 months after switching from peritoneal dialysis (PD) to hemodialysis (HD) due to an episode of refractory culture-negative peritonitis (CNP). Abdominal paracentesis yielded inflammatory ascites, which later grew Cladosporium cladosporioides, establishing the diagnosis of fungal peritonitis. She was successfully treated with a 4-week course of oral voriconazole. Cladosporium spp. are common fungi in the environment but rarely cause PD-associated peritonitis and can be challenging to diagnose with conventional microbiologic evaluation. In summary, PD-associated peritonitis can worsen after a patient switches to HD. Therefore, it is essential to maintain a high level of suspicion for such complications related to their previous dialysis modality to arrive at an accurate diagnosis.

Keywords: Ascites; Cladosporium; Culture negative peritonitis; Fungal peritonitis.

Publication types

Case Reports