Peritonitis due to Mycobacterium abscessus in peritoneal dialysis patients: case presentation and mini-review

Abstract Background Peritoneal dialysis (PD)-associated peritonitis caused by nontuberculous mycobacteria (NTM), including Mycobacterium abscessus (M. abscessus), is a rare but serious complication that forces PD to be withdrawn. Several cases of peritonitis by NTM have been reported, and optimal treatment has not yet been established. Case presentations We report two cases of PD-associated peritonitis caused by M. abscessus. In both cases, peritonitis developed after an exit-site infection. The patients did not have any typical signs of peritonitis or an elevated nucleated cell count of the dialysis effluent in the early phase. In addition, effluent cultures were negative at admission in both cases, although M. abscessus was identified in effluent cultures in the late phase. One patient recovered after the PD catheter was removed, and multi-antibiotic treatment was administered for 6 months. The other patient subsequently developed encapsulating peritoneal sclerosis (EPS) 16 months after the onset of infection. In addition, the EPS was complicated by intestinal perforation into infected ascites. The infection resolved with antibiotic treatment and octreotide administration to diminish bowel leakage into the infected cavity. Conclusions The combination of amikacin, clarithromycin, and imipenem/cilastatin with PD catheter removal may be effective for the treatment of M. abscessus PD-associated peritonitis. The prognosis of M. abscessus-induced peritonitis is generally poor, and it is of note that residual encapsulated ascites in the peritoneal cavity after treatment may increase the risk of infection recurrence or EPS development