Biopsy-confirmed Mycobacterium kansasii peritonitis with CT peritoneography in a young PD patient: a case report
Abstract
Background: Mycobacterium kansasii is an exceptionally rare cause of peritoneal dialysis (PD)-related peritonitis and may present with subtle, indolent features that delay recognition. This case illustrates how "silent" atypical peritonitis can be unmasked by pairing contrast-enhanced computed tomography (CT) with CT peritoneography: the former identified nodular biopsy targets, while the latter revealed loculated dialysate flow and failure of free intraperitoneal circulation.
Case presentation: A 20-year-old male had received automated PD for 3 years and was being evaluated for combined heart-kidney transplantation because of severe cardiomyopathy. He presented with vague abdominal discomfort, declining ultrafiltration, mild pedal edema, and weight loss. PD effluent (PDE) showed mononuclear-predominant leukocytosis (49-150 cells/µL), but repeated PDE cultures, AFB staining, and molecular testing were negative. Contrast-enhanced CT revealed multiple peritoneal nodules and omental stranding; CT peritoneography exposed a trapped contrast-containing pocket, providing functional evidence of impaired dialysate circulation. Ultrasound-guided biopsy showed necrotizing granulomatous inflammation, and tissue culture subsequently grew M. kansasii with rifampicin resistance. Because the isolate was also resistant to moxifloxacin and ciprofloxacin, fluoroquinolone-based therapy was avoided. Guided by susceptibility testing, we treated him with isoniazid, azithromycin, ethambutol, and…
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