Medical Case Reports

Biography

Biography: Mohammed Atef El Naggari

Abstract

Peritonitis is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and represents the most frequent cause of peritoneal catheter loss and discontinuation of CAPD. Common bacteria, particularly staphylococcal species are the usual causative agents. Fungi and higher bacteria such as Nocardia asteroides as etiological agents have been infrequent in patients undergoing CAPD. We report a 13 years old female with chronic renal failure, who was on CAPD for the last 3 years. She presented with peritoneal catheter exit site and tunnel infection. The condition progressed to frank clinical and laboratory evidence of peritonitis. The course of infection was stormy not responding to several combinations of antibiotics and then progressed to septic shock and cardiac arrest. Nocardia asteroides was isolated after two weeks after high index of suspicious. This is first case report in pediatrics which was complicated by an intra-abdominal abscess that required ultrasound guided drainage and a protracted long course of linizolid antibiotic. Linizolid was given IV for 3 months in hospital then orally for 5 months with close monitoring of side effects. Patient discharged home after 3 month of hospitalization on hemodialysis. In literature, a total of 11 adult patients reported with Nocardia peritonitis. None of the reported cases used linizolid as an option in the treatment. So, this is the first report of using linizolid in Nocardia species related peritonitis. Diagnosis and management can be problematic due to the slow growth and difficult identification of Nocardia species. The optimal duration of treatment for Nocardia peritonitis is not known. Finally, protracted linizolid can be used for treatment of Nocardia peritonitis in trimethoprim-sulphamethoxazole resistant cases. Linizolid can be used for pediatric age group with close monitoring of side effects.