Atypical zoonotic peritoneal dialysis–related peritonitis

ABSTRACT

Zoonotic organisms are an uncommon but increasingly recognized cause of peritoneal dialysis (PD)-related peritonitis, particularly among patients with close exposure to animals. We report the case of a young male end-stage renal disease on PD and newly diagnosed liver cirrhosis who developed refractory PD-related peritonitis caused by the rare zoonotic pathogens Pasteurella dagmatis and Neisseria zoodegmatis following contamination of the peritoneal dialysis equipment by cat saliva. Despite treatment with intraperitoneal and oral antimicrobial therapy, as well as a PD catheter removal, the patient’s symptoms persisted and relapsed, ultimately resolving only after a prolonged course of cefepime combined with oral metronidazole. This case highlights the challenges associated with managing PD-related peritonitis caused by rare zoonotic organisms, as well as the potential impact of host factors such as cirrhosis on treatment response. It also emphasizes the importance of avoiding animal exposure in patients undergoing peritoneal dialysis.

Keywords: Peritonitis, zoonotic infection, cirrhosis