Critical peritonitis secondary to gastrointestinal mucormycosis in a peritoneal dialysis patient: a case report

Immunodeficient patients are susceptible to systemic fungal infections; however, these rarely cause secondary peritonitis. A 66-year-old man with multiple myeloma and diabetes mellitus on continuous ambulatory peritoneal dialysis (CAPD) presented with cloudy ascitic fluid. He had been treated with corticosteroids for 1 month for Tolosa–Hunt syndrome. We diagnosed peritoneal dialysis-related peritonitis caused by Enterococcus avium, removed the CAPD catheter, and initiated intravenous ampicillin. Computed tomography (CT) revealed an intramural gastric mass and a thinning ascending colon wall. Four days later, follow-up contrast-enhanced CT showed penetration of the ascending colon and rupture of the ileocolic artery. Emergency open surgery revealed hemorrhagic infarction with mucormycosis. We initiated intravenous liposomal amphotericin B 20 days after admission; however, he died 55 days later. Anatomical abnormalities, such as gastrointestinal perforation, should be considered for peritonitis in immunodeficient patients. Gastrointestinal mucormycosis is rare but fatal, resulting from a delay in diagnosis and consequent gastrointestinal perforation. For an early diagnosis and a favorable clinical outcome, it is important to consider the risk factors for mucormycosis, including corticosteroid use, diabetes, end-stage kidney diseases.