Peritonitis due to Candida rugosa: the first case report.

Editor: A 31-year-old female patient who had been receiving continuous ambulatory per itoneal dialysis (CAPD) therapy for approximately 2 years because of end-stage renal disease of unknown cause presented with abdominal pain, nausea, vomiting, and cloudy dialysate for 3 days. She had no history of peritonitis. The exit site and tunnel of the CAPD catheter were found to be normal. White blood cell (WBC) count of the peritoneal fluid was 1200/mm 3 , with lymphocytes predominant. Gram stain of the peritoneal fluid did not show any microorganisms. After microbiological evaluation, she was empirically started on an antibiotic regimen consisting of cefazolin and amikacin intraperitoneally. Despite the empiric combined antibiotic treatment, the patient’s clinical status did not improve. Her peritoneal fluid WBC count continued to be 600 ‐ 800/mm 3 , with lymphocytes predominating. On the ninth day after her admission to the hospital, yeast growing in the peritoneal fluid culture was identified as Candida rugosa. For the strain of Candida rugosa isolated from the patient, the minimum inhibitory concentrations of amphotericin B, fluconazole, ketoconazole, and itraconazole were 0.5 μL/mL, 1.5 μL/mL, 0.032 μL/mL, and 2 μL/mL, respectively. The CAPD catheter was removed immediately and intravenous antifungal therapy with amphotericin B was started. She was switched to hemodialysis. Three weeks later, the patient’s clinical condition was entirely recovered. Intravenous amphotericin B was continued for 6 weeks and she was discharged without any problem. Candida non-albicans species have emerged over the past 15 years due to the widespread use of fluconazole and other well-tolerated antifungal agents and the increasing numbers of at-risk patients (1). Candida rugosa is a well-described cause of mastitis and other infections in dairy herds and it is an emerging fungal pathogen in humans, with frequency of isolation increasing from 0.03% to 0.4% between 1997 and 2003 in a large international repository of clinical isolates (2,3). Infections caused by Candida rugosa are frequently associated with burn wounds, surgical nystatin prophylaxis, catheters, and other intravenous devices, as in our patient (4‐7). In treating fungal CAPD-related peritonitis, immediate catheter removal is indicated because fungal peritonitis