The first case report of hemorrhagic peritonitis caused by Aureimonas ureilytica infection in a peritoneal dialysis patient

Abstract We report, for the first time, the isolation of Aureimonas ureilytica from peritoneal dialysate effluent of a Japanese man in his 50s who underwent combined therapy with peritoneal dialysis (PD) and hemodialysis for end-stage kidney disease secondary to diabetic kidney disease. He presented with cloudy peritoneal dialysate effluent, accompanied by abdominal pain, and requested an emergency consultation. Blood tests showed severe acute inflammation, and the dialysate analysis revealed 3365 leukocytes/μL, with a predominance of neutrophils. He was diagnosed with PD-related peritonitis and was treated with antibiotics consisting of ceftazidime and vancomycin; however, leukocyte count in the dialysate effluent did not decrease significantly. Furthermore, bloody peritoneal dialysate effluent with clots appeared, which is an unusual manifestation during the clinical course of PD-related peritonitis, making dialysate exchange difficult. Tenckhoff catheter was removed, and the patient was converted to thrice-weekly hemodialysis. Because the results of the peritoneal dialysate culture were inconclusive, we added 16S rRNA gene sequence analysis for confirmation, which showed approximately 100% homology with the sequence of Aureimonas ureilytica. To date, little is known about the pathogenicity of this bacterium owing to a lack of reports on human infections. The present case highlights the significance of 16S rRNA sequencing, which could improve the current clinical management of PD-related peritonitis by accurately detecting infrequently encountered pathogens in clinical practice.