Peritoneal dialysis-associated peritonitis: A rare case of bacterial translocation from advanced colorectal cancer

Abstract

Peritoneal dialysis (PD) -associated peritonitis is a common complication in PD patients, often attributed to touch contamination and exit-site infections. This report describes a rare case in which bacterial translocation from advanced colorectal cancer was considered as the underlying cause of PD-associated peritonitis. A 78-year-old female with chronic kidney disease (CKD) underwent PD at our hospital four years ago. She presented with cloudy effluent and abdominal pain, leading to a diagnosis of PD-associated peritonitis and subsequent hospitalization. Intraperitoneal cefotaxime (CAZ) and intravenous vancomycin (VCM) were initiated, improving the abdominal pain and cell count. Due to the favorable susceptibility of Escherichia coli isolated from effluent culture, CAZ was switched to cefazolin (CEZ) on the 6th day. However, recurrence of an elevated effluent cell count on the 9th day prompted consideration of bacterial translocation from organic lesions in the intestine. Colonoscopy revealed a type 2 (ulcerative localized) tumor in the transverse colon, leading to a diagnosis of bacterial translocation due to colorectal cancer. In cases of recurrent elevation of the effluent cell count during PD-associated peritonitis treatment, consideration of colorectal malignancy as a potential cause of secondary infection from intraperitoneal organs is important to facilitate a thorough examination.