Brucella Peritonitis in a Patient on Peritoneal Dialysis: A Case Report and Review of Literature

Peritoneal dialysis (PD)-associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients on PD. Brucellosis is a worldwide zoonotic infectious disease caused by gram-negative bacteria of the genus Brucella. It is a major public issue in some regions. According to the World Health Organization report in 2011, the Kingdom of Saudi Arabia is considered endemic for brucellosis. Brucella peritonitis is one of the rarest presentations of Brucella. We report a case of a 14-year-old girl known to have end-stage renal disease, secondary to the autosomal recessive polycystic kidney. She had congenital hepatic fibrosis and pancytopenia. She had been undergoing automated PD for the past seven years and presented with abdominal pain, seizure, and poor feeding. There was no history of ingestion of unpasteurized milk or contact with raw infected animal products. The color of PD fluid was turbid with leukocytosis, predominantly neutrophils. The peritoneal fluid culture was positive for methicillin-resistant Staphylococcus aureus. The patient was started on intraperitoneal vancomycin, which showed slow improvement. The second culture of the peritoneal fluid showed Brucella species after a few days. Blood culture and serum serology titer for Brucella showed negative results. An anti-Brucella regimen, including rifampin and doxycycline, was initiated. She was treated with this regimen for six weeks. After the initiation of the anti-Brucella regimen, she showed marked improvement. To the best of our knowledge, only a small number of cases of Brucella peritonitis in PD patients have been reported. Despite the rarity of Brucella as a peritonitis-causing organism, it should be considered as a relevant pathogen in peritonitis cases, especially in endemic regions. PD-associated Brucella peritonitis is rare, and PD catheter saving may be considered if there is a response to anti-Brucella treatment.