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