PERITONITIS DUE TO ASPERGILLUS NIGER IN A CHILD ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

Peritonitis is the most frequently encountered serious complication of continuous ambulatory peritoneal dialysis (CAPD). Fungal peritonitis is relatively uncommon and Aspergillus Niger peritonitis is extremely rare in CAPD patients.

A 12-year-old girl with rapidly progressive glomerulonephritis was started on CAPD programme in April 1994 despite of pulse methyl-prednisolone and cyclophosphamide therapy. During the next four months, she experienced three episodes of catheter drainage problem. Gram stains and cultures of dialysate were negative in each episodes. At the fourth episode, peritoneal fluid was slightly cloudy with numerous cells, predominantly lymphocytes. Cultures of Sαbouraud's agar of two consecutive specimens ofdialysate isolated Aspergillus Niger. The patient was given IV and IP fluconazole for 10 days, then Tenckhoff catheter was removed. Fluconazole was continued only IV, until 17th day of treatment. At this time the Tenckhoff catheter was reinserted and antifungal therapy was completed for four weeks by IV and IP. The patient returned successfully CAPD therapy by this protocol

With this report, we emphasized that Aspergillus peritonitis could lead the drainage problem in children and treatment had to be instituted immediately after diagnosis.