Cryptococcal peritonitis in peritoneal dialysis patients: a case report.

Peritonitis in patients on chronic peritoneal dialysis remains a major problem. Most commonly this is due to bacterial infection, but fungal peritonitis is also a treatment dilemma. Peritonitis due to Cryptococcus neoformans is an unusual event, with fewer than ten cases reported. This case report documents a case of cryptococcal peritonitis in a diabetic man on prednisone and azathioprine for suspected chronic inflammatory demyelinating polyneuropathy. The organism was also cultured in the cerebrospinal fluid and urine and high cryptococcal antigen titers were found in the blood indicating systemic infection. The peritoneal catheter was removed, immunosuppression was withdrawn and he was treated with systemic antifungal therapy. He died suddenly nine weeks following the diagnosis and at post mortem was found to have evidence of cryptococcosis in lung, spleen and brain. The case demonstrates that cryptococcal peritonitis in patients on peritoneal dialysis should prompt a search for systemic infection and may require prolonged therapy.