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| 지속성 외래 복막투석 중 발생한 Cryptococcus 복막염 및 뇌막염 1예 |
| 김진안 , 조재용 , 박찬신 , 김기용 , 김흥수 , 이호영 , 한대석 , 정윤섭 |
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| Abstract |
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Peritonitis is a major and potentially serious compli- cation of continuous ambulatory peritoneal dialysis (CAPD). Over 70@9@6 of these infections are caused by Gram-positive bacteria. Fungal infections account for between 1 to 10% episodes of peritonitis complicating CAPD. Candida species account for the majority (approximately 75%) of such infections. Cryptococcal peritonitis complicating CAPD is rare, and only five cases have been reported in the world-wide literature. We report a case with ESRD due to lupus nephritis who developed cryptococcal peritonitis during CAPD as the initial manifestation of cryptococcosis. A 17-year-old man with lupus nephritis had been maintained on contiunuous ambulatory peritoneal dialysis for 10 months when he developed abdominal pain, headache, and chilling sensation and was noted to have cloudy dialysate fluid. His past history was signifi- cant for three previous episodes of CAPD peritonitis, and all successfully treated with intraperitoneally ad- ministered antibiotics. On this presentation, analysis of the peritoneal fluid revealed 180 white blood cells/mm with 10% polymorphonuclear cells, 87% lymphocytes. The yeast isolated on Sabouraud glucose agar was identified as Cryptococcus neoformans. A lumbar punc ture was performed and the cerebrospinal fluid (CSF) showed 17 WBC/mm with 2% segs, 97% lymphocytes. The cryptococcal antigen was positive in both CSF and serum. The CAPD catheter was removed and he was maintained on hemodialysis. The patient received a total of 2 2 gm of IV amphotericin B over 9 weeks. Repeat cryptococcal antigen titers were negative 9 weeks after diagnosis and he was discharged to be treated with oral fluconazole. |
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