Fungal Peritoneal Dialysis-Associated Peritonitis as a Silent Threat: The Critical Role of Early Diagnosis and Catheter Removal.

Fungal peritonitis is an uncommon but serious complication that can occur in patients undergoing peritoneal dialysis. It represents a small percentage of all peritonitis cases in these patients. Its diagnosis can be challenging due to the slow growth of fungi and frequent negative culture results. We report a case of fungal peritonitis in a 71-year-old man on automated peritoneal dialysis (APD). The patient presented with relapsing peritonitis unresponsive to antibiotics. During catheter removal, fungal hyphae were identified, confirming fungal peritonitis despite negative cultures. Prompt catheter removal and antifungal therapy with fluconazole led to infection resolution. The patient transitioned to hemodialysis. This case highlights the importance of early suspicion and intervention in fungal peritonitis. Prolonged antibiotics and recurrent infections should raise concern for fungal etiology, particularly in refractory cases. Early catheter removal, combined with targeted antifungal therapy, is critical to successful outcomes. Our findings emphasize the diagnostic challenges of fungal peritonitis and the need for advanced microbiological techniques and collaborative care between clinicians and microbiologists.