Refractory Peritonitis and Small Bowel Ileus: A Case of Encapsulating Peritoneal Sclerosis Secondary to Mycobacterium abscessus Peritonitis

Abstract

Introduction: Complications of peritoneal dialysis (PD) such as exit-site infections and PD peritonitis are common reasons for admission to General Internal Medicine wards. Culprit organisms range from typical skin flora to rarer complicated atypical organisms such as non-tuberculous mycobacteria. Encapsulating peritoneal sclerosis (EPS) is a rarer complication of PD characterized by peritoneal inflammation, ileus and fibrosis with high morbidity, few management options, and poor prognosis. Case Description: We report the case of a patient with a history of end-stage renal disease on peritoneal dialysis who presented with undifferentiated peritonitis and ileus refractory to standard antimicrobial therapy. Subsequent ascitic cultures were positive for Mycobacterium abscessus, and CT imaging was consistent with EPS. To date, EPS secondary to M. abscessus peritonitis has not previously been described. Discussion and Conclusion: This report describes the diagnostic process and treatment offered to this patient and his treatment outcomes over 8 months. It highlights the importance of prompt identification of patients at risk, timely eradication of high-risk pathogens, and transition to haemodialysis to limit morbidity and improve patient prognosis.

Peritoneal dialysis-related peritonitis with encapsulated ascites due to Mycobacterium abscessus subsp. massilience and subsp. bolletii: a case series and literature review

“…Interestingly, the organisms in all these cases were Mycobacterium abscessus. Additionally, three cases of EPS [9,11,12] and two cases of adhesive ileus [13] (including our second case) were reported. The culprit pathogens were Mycobacterium fortuitum in one case [11] and Mycobacterium abscessus in four cases [9,12,13].…”

“…Additionally, three cases of EPS [9,11,12] and two cases of adhesive ileus [13] (including our second case) were reported. The culprit pathogens were Mycobacterium fortuitum in one case [11] and Mycobacterium abscessus in four cases [9,12,13]. These findings suggested that Mycobacterium abscessus tends to form encapsulated cavities and/or intestinal adhesions compared to other NTMs.…”

“…Including the current two cases, only five cases of NTM peritonitis with encapsulated ascites were reported [8][9][10], one of which was accompanied by EPS [9]. Interestingly, the organisms in all these cases were Mycobacterium abscessus.…”

“…We conducted a systematic review of the literature focusing on PD-related peritonitis caused by NTM since May 2011 because there has already been a systematic review of the cases reported in PubMed up to April 2011 [17]. The number of cases with NTM peritonitis reported in PubMed from May 2011 to December 22, 2022, was 61, including our two cases (Tables 1 and 2) [6,[8][9][10][11][12][13]. Therefore, combined with the 57 cases reported up to April 2011 [17], the number of cases with NTM peritonitis reported in PubMed to date is 118.…”

“…Therefore, treatment for NTM peritonitis needs to be case-dependent, which is often difficult. Additionally, several reported cases were accompanied by encapsulated ascites, adhesive ileus, and encapsulating peritoneal sclerosis (EPS), all of which suggest treatment difficulties [8][9][10][11][12][13]. In this paper, we report two rare cases of PD-related peritonitis with encapsulated ascites due to Mycobacterium abscessus.…”