Peritoneal dialysis-associated peritonitis caused by Ureaplasma urealyticum: A case report.
Ting Hu, Jinjin Zhang, Geping Yu
✦ AI-curated · Sources linked
Case in brief
A 41-year-old woman on continuous ambulatory peritoneal dialysis for more than 10 years developed acute abdominal pain, fever, cloudy dialysate, and neutrophilic dialysate leukocytosis. Repeated bacterial and fungal cultures and acid-fast staining were negative. Targeted next-generation sequencing of dialysate detected Ureaplasma urealyticum, considered the most likely cause. Empirical vancomycin-based regimens were ineffective; treatment was adjusted to doxycycline and levofloxacin, then intravenous azithromycin after a vaginal isolate was found resistant to levofloxacin. Symptoms and dialysate findings resolved, the catheter was retained, and there was no recurrence during 1-month follow-up.
What made this case unusual
The organism was identified by targeted next-generation sequencing despite repeatedly negative conventional microbiological tests; a vaginal isolate also revealed levofloxacin resistance, prompting a further treatment change.
Diagnostic / clinical pearl
In persistent, culture-negative peritoneal dialysis-associated peritonitis unresponsive to cell wall-active antibiotics, consider cell wall-deficient organisms such as Ureaplasma. Interpret sequencing results in clinical context and, when possible, seek confirmation by an independent method.