Clinically suspected delayed kidney graft infection following treatment for peritoneal dialysis-related peritonitis caused by Candida parapsilosis: a case report

Background Peritonitis is a major complication affecting the survival of patients on peritoneal dialysis (PD). Fungal peritonitis is particularly treatment-resistant, often requiring catheter removal. We report a rare case of invasive candidiasis in a PD patient, which eventually led to infection of a failed kidney graft and required graftectomy. Case presentation A 47-year-old man with a history of kidney transplantation for IgA nephropathy experienced kidney graft failure due to antibody-mediated rejection that developed soon after transplantation in Year X − 3. PD was initiated in Year X − 2. In Year X, he was admitted to initiate hemodialysis for fluid management. Upon admission, hemorrhagic PD effluent was noted, and fungal peritonitis caused by Candida parapsilosis was diagnosed. Despite six weeks of antifungal therapy and percutaneous drainage of a newly developed intraperitoneal abscess, he developed recurrent fever two weeks after discharge. Computed tomography revealed a severe delayed infection involving the non-functioning kidney graft, and the patient’s clinical condition and inflammatory markers improved significantly following graftectomy. Conclusion C. parapsilosis infections can be prolonged and complicated by abscess formation. Clinicians should remain vigilant for delayed kidney graft candidiasis in patients undergoing PD after kidney graft failure, even when the initial fungal peritonitis appears resolved.