A case of peritoneal dialysis-associated peritonitis caused by Rhodococcus pyridinivorans

Rhodococcus infections are exceedingly rare and largely reported in immunocompromised hosts, with no consensus on optimal therapy due to limited evidence. This article reports for the first time a case of peritoneal dialysis–associated peritonitis caused by Rhodococcus pyridinivorans in a patient with diabetic nephropathy. The dialysate leukocyte count declined substantially with combination antimicrobial therapy, but complete normalization occurred only after replacing icodextrin with a glucose-based dialysate. These findings support the use of combination regimens and emphasize the need to consider icodextrin-associated sterile peritonitis when dialysate abnormalities persist despite appropriate antimicrobial treatment.