Patient

The patient was a 17-year-old black female who was maintained on CCPD for more than seven years. Her course on dialysis was complicated by numerous episodes of bacterial peritonitis. During the most recent 12-month period, there were five episodes of peritonitis due to gram-positive and gram-negative bacteria. No fungi were isolated from any of the peritoneal fluid cultures. Antibiotic therapy included numerous intraperitoneal courses of broad spectrum antibiotics. The patient had been on intraperitoneal cefotaxime and vancomycin for two weeks for treatment of peritonitis when she developed intermittent abdominal pain and transient cloudy dialysate efflu ent. Three separate samples of peritoneal fluid were obtained over the next 11 days. Each of the samples grew the syncephalastrum species but no bacteria. The cell count and differential of the first dialysate fluid sample demonstrated a predominance of polymorphonuclear leukocytes (PMN) (Table 1). The peritoneal catheter was removed, and the patient's dialysis therapy was converted to hemodialysis at the patient's request. The patient received 10 days of amphotericin B and her symptoms resolved