Relapsing peritoneal dialysis-associated peritonitis caused by Corynebacterium striatum: a case report.

Abstract

Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD, and its prevention and treatment are important for reducing patient morbidity and mortality. Reports of PD-associated peritonitis caused by Corynebacterium spp. are limited, and PD-associated peritonitis caused by Corynebacterium striatum (C. striatum) is rare. Only two case reports are available, wherein improvement was only achieved after intraperitoneal administration of antibiotics. Here, we report a case of relapsing PD-associated peritonitis caused by C. striatum that did not improve with antibiotic therapy. In this case, the patient started PD due to end-stage renal failure with immunoglobulin A nephropathy. In addition, he had been diagnosed with bronchiectasis and was prescribed clarithromycin. Four days after PD induction, the patient developed culture-negative PD-associated peritonitis. Ceftazidime and cefazolin were subsequently administered intraperitoneally for a total of 14 days, resulting in improvement in his condition. However, 3 and 5 months after PD induction, he developed PD-associated peritonitis again, and C. striatum was detected in each culture. He was treated with intraperitoneal vancomycin for a total of 14 days and improved; however, he developed PD-associated culture-negative peritonitis again 7 months later. We diagnosed relapsing PD-associated peritonitis caused by C. striatum. PD catheter removal and reinsertion were performed, and he has not relapsed since. In conclusion, PD-associated peritonitis caused by C. striatum may have a poor prognosis; therefore, PD catheter removal is recommended, especially in patients with a history of repeated PD-related peritonitis due to C. striatum.