RECURRENT POL YMICROBIAL PERITONITIS FROM A GYNECOLOGIC SOURCE AS A COMPLICATION OF CAPO

A 22-year-old woman on CAPD developed recurrent peritonitis with organisms suggestive of a gynecologic source. A concomitant vagi nalleaking of dialysate confirmed an abnormal communication between peritoneum and vagina. The recurrent infection led to fungal over-growth, abcess formation and catheter loss. The appearance of peritoneal infection with normal vaginal organisms should prompt a search for a gynecologic source of contamination such as that demonstrated in this case. Experience with continuous ambulatory peritoneal dialysis (CAPD) has shown that certain underlying medical conditions may predispose patients to the development of complications such as peritonitis. Among these predisposing conditions are anatomic abnormalities such as diverticulitis and in-cipient subcutaneous catheter infections, or constitutional factors such as leukopenia, diabetes mellitus, concomitant corticosteroid therapy, or underlying malignancy (1-3). It has also been suggested that gynecologic infection may predispose to peritoneal infection, either through proximate pelvic inflammatory disease or through reflux of vaginal contents into the Fallopian tubes (4). The following case, an unusual example of recurrent peritonitis in a young woman repr