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KMID : 0359919930120040705
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Korean Journal of Nephrology
1993 Volume.12 No. 4 p.705 ~ p.710
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A Case of Cryptococcal Peritonitis and Meningitis in a CAPD Patient with SLE
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김진안
조재용/박찬신/김기용/김홍수/이호영/한대석/정윤섭
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Abstract
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Peritonitis is a major and potentially serious compolication of continuous ambulatory peritoneal dialysis (CAPD). Over 70% of these infections infections are caused by Gram-positive bacteria. Fungal infections account for between 1 to 10%
episodes
of
peritonitis complicating CAPD. Candida species account for the majority (approximately 75%) of such infections. Cryptococcal peritonitis complicating CAPD is rare, and only five cases have been reported in the world-side literature. We report a
case
with ESRD due to lupus nephritis who developed cryptococcal peritonitis during CAPD as the initial manifestation of cryptococcosis.
A 17-year-old man with lupus nephritis has been maintained on contiunuous ambulatory peritoneal dialysis for 10 months when developed abdominal pain, headache, and chilling sensation and was noted to have cloudy dialysate fluid. His past history
was
significant for three previous episodes of CAPD peritonitis, and all successfully treated with intraperitoneally administered antibiotics. On this presentation, analysis of the peritoneal fluid revealed 180 white blood cells/㎣with 10%
olymorphonuclear
cells, 87% lyjphocytes. The yearst isolated on Sabouraud glucose agar was identified as Cryptococcus meoformans. A lumbar puncture was performed and the ecerebrospinal fluid (CSF) showed 17 WBC/㎣with 2% segs, 97% lymphocytes. The cryptococcal
antigen
ws positive in both CSF and serum. The CAPD catheter was removed and he was maintatined on hemodialysis. The patient received a total of 2.2 gm of IV amphotericin B over 9 weeks. Repeat cryptococcal antigen titers were negative 9 weeks after
diagnosis
and he was discharged to be treated with oral fluconazole.
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