Abstract
Peritonitis is one of the major complications of continuous ambulatory peritoneal dialysis (CAPD). We report a case of Campylobacter peritonitis in a patient on CAPD, which is very rare. Only 14 cases have previously been reported.
A 43-year-old woman, who had been treated with hemodialysis since 1970, started CAPD in 1985 because of obstruction of an arteriovenous fistula which was difficult to repair. Subsequently, she had often developed peritonitis. On July 5, 1991, she suffered from diarrhea with fever, and developed peritonitis after this episode. She was admitted to our hospital on July 8 since laboratory examination showed a CRP of 50.5mg/dl and 277 leukocytes/mm3 in the dialysate. The dialysate on admission was cultured and found to be positive for Campylobacter fetus. The patient, who reported an anaphylactic reaction to penicillins and cephalosporins, was treated with vancomycin, tobramycin and minocycline. Cultures later became negative for Campylobacter fetus, but positive for Enterococcus faecalis as a result of superinfection. A barium enema examination revealed a diverticulum in the ascending colon. She failed to respond to therapy because drug allergy prohibited appropriate antibiotic treatment. On August 21, as a result of persistent peritonitis evolving into sclerosing peritonitis, the Tenckhoff catheter was removed and hemodialysis was started with an intravenous catheter in the right subclavian vein. The peritonitis might have been caused by transmural migration through the intestinal wall after oral ingestion of Campylobacter fetus, although the route of infection is unknown.
