Bacillus subtilis-associated abdominal catastrophe in a Japanese patient with peritoneal dialysis-related peritonitis

Abstract Abdominal catastrophe in patients with peritoneal dialysis (PD) is a condition in which visceral injury may cause leakage of enteric microorganisms into the peritoneal cavity, resulting in peritonitis. A 50-year-old Japanese male, who had been on PD for 5 years, was diagnosed with PD-related peritonitis. The initial peritoneal fluid culture detected Bacillus subtilis and Enterococcus faecalis. Antibiotic treatment was immediately initiated. Abdominal computed tomography (CT) revealed a pelvic abscess and ileus without mechanical obstruction. We consulted with surgeons regarding surgical intervention. Since mechanical obstruction or perforation was not detected in the initial abdominal CT, abscess drainage was recommended. However, the fever recurred. Abdominal CT performed for the seventh time identified a fistula between the sigmoid colon and pelvic cavity. Surgical removal of the colon was performed. Herein, we elucidate a very rare case of Bacillus subtilis-associated abdominal catastrophe and discuss the clinically important aspects of it.