He visited our hospital due to fever lasting for 7 days with cloudy dialysate. He was on no immunosuppressive therapy, was known to be human immunodeficiency virus (HIV) negative, and had no previous episodes of peritonitis. Physical examination found no signs other than pyrexia (37.3°C). The white blood cell count of the CAPD fluid was 3,500/μL, and serum C-reactive protein (CRP) levels were elevated. We performed Gram staining
using centrifuged sediment of the peritoneal effluent, and identified yeast cells with large Gram-positive budding by microscopy. Based on these findings, we started administration of intravenous micafungin and oral fluconazole. The peritoneal catheter was removed on day 7 after admission. Cryptococcus sp. was isolated on day 10 of hospitalization, Alvelestat cell line and the antibiotic regimen was altered. Based on the results of antifungal susceptibility testing, voriconazole was administered. A search for disseminated disease was also performed, including microbiological studies of blood and sputum; however, both were negative. CRP levels improved and the patient was discharged on day 18. He has been
in good condition for 1 year after completing 3 months of antibiotic therapy. Later, genetic Stem Cells inhibitor testing revealed the pathogen as Cryptococcus laurentii (C. laurentii). Discussion: Fungal peritonitis is serious and leads to death in approximately 25% or more of episodes. Cryptococcus peritonitis is an unusual form of PD-related peritonitis. To the best of our knowledge, only 2 cases of peritonitis caused by C. laurentii have been reported in PD patients. Both were adolescent females, and were not on immunosuppressive therapy. It is reported that the presence many of an invasive device is a significant risk factor for C. laurentii infection. In the present patient, as well as in the two previous cases in the literature, we could not determine any risk factors other than a PD catheter with end-stage renal disease (ESRD). The PD catheter was removed in all cases, and all patients survived. Conclusion: C. laurentii infection can occur in
young people who have no risk factors other than PD catheter with ESRD. Prompt catheter removal and anti-fungal therapy effectively treat the infection. JUNG HEE-YEON, KWON EUGENE, KIM HYUN-JI, KWON OWEN, CHOI JI-YOUNG, CHO JANG-HEE, PARK SUN-HEE, KIM CHAN-DUCK, KIM YONG-LIM Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital Introduction: Previous studies have suggested the association between thyroid hormones and mortality in dialysis patients. However, little is known regarding the association of free thyroxine and mortality in peritoneal dialysis (PD) patients. This study assesses the association between basal and annual variation of free thyroxine and mortality in PD patients.