DISAPPEAR - DIScharge of Acute Pancreatitis Patients EARlier (original) (raw)

Case Report inTrOduCTiOn Continuous ambulatory peritoneal dialysis (CAPD) is a form of renal replacement therapy for patients with end-stage kidney disease. Older patients with multiple comorbidities who desire home therapy is an indication for CAPD. Diabetes mellitus and old age produce senescence of the immune system and predispose patients to catheter-related infections. Peritoneal dialysis and in particular CAPD are associated with a high risk of peritonitis, tunnel infection (TI) and catheter exit-site infection (ESI). [1] Catheter ESI and TI are a major source of morbidity. ESI and TIs increase the risk of catheter loss, peritonitis and overall PD technique failure. [2] Majority of the ESIs are caused by Gram-positive organisms and can be successfully treated by appropriate antimicrobial therapy for a period of 2-3 weeks without catheter loss. [3] Non-tuberculous mycobacterium (NTM) is a very rare cause of ES and TI and requires catheter removal for management along with antimicrobial therapy. Mycobacterium abscessus is a rapidly growing NTM and rarely causes TI among PD patients. It is usually difficult to treat M. abscessus because of its resistant nature to most of the antibiotics. [4] TI may present as erythema, oedema or tenderness over the subcutaneous site but is often clinically occult, as shown by ultrasound studies. [5] TI usually occurs in the presence of an ESI but rarely occurs alone. Here, we described an early onset of NTM in an 82-year-old T2D patient on CAPD. Atypical mycobacteria remain a rare cause of peritoneal dialysis catheter-related tunnel infection (TI) and poses serious risk because of the resistant nature to most antibiotic therapy. Non-tubercular mycobacterial infections lead to chronicity requiring peritoneal dialysis catheter removal. We report an 82-year-old male, with diabetic nephropathy who had a coinfection with Staphylococcus hominis and Mycobacterium abscessus who presented with pus discharge at exit site and TI. He was treated with relocation of the extraperitoneal part of the catheter with a new exit site without catheter removal and multidrug mycobacterial therapy.