Peritoneal Dialysis Catheter-Associated Peritonitis Caused by Mycobacterium abscessus: A True Infection?

A nine-year-old male with trisomy 21, end-stage renal disease (ESRD) due to reflux nephropathy presented with suspected peritoneal dialysis (PD) catheter-associated peritonitis. One week after receiving an intraperitoneal antibiotic, he presented again with persistent peritonitis symptoms and bloody PD fluid. He underwent exploratory laparotomy, abdominal washout, and PD catheter removal. Mycobacterium abscessus (M. abscessus) was found in the intraoperative peritoneal fluid culture. After the catheter removal, the child's symptoms significantly improved without antimicrobial medications. He was maintained on hemodialysis three times a week and underwent a successful kidney transplant eight months after this episode. Non-tuberculous mycobacterial peritonitis should be considered in patients with culture-negative peritonitis when there is no intraperitoneal antibiotic response. M. abscessus is a rapidly growing atypical Mycobacterium found in the environment and can contaminate medical devices. Our case involved an infection from a contaminated PD catheter since the patient's symptoms improved after PD catheter removal.