peritonitis is one of the most common factors responsible for morbidity and mortality in patients on continuous ambulatory peritoneal dialysis ( capd ) .
approximately 48% of peritonitis episodes have a fungal etiology , candida species accounting for 75% .
the reported incidence of mortality in bacterial peritonitis is approximately 0.63% and that in fungal peritonitis is 1244% .
so , it is imperative that fungal peritonitis is diagnosed rapidly and appropriate treatment given so that the survival rates are improved .
paecilomyces species are saprophytic fungi and are uncommon pathogens that can produce serious infections in immunocompromised patients and occasionally in immunocompetent hosts .
reddy et al . reported a case of fungal peritonitis caused by paecilomyces puntonii from india .
we report a case of fungal peritonitis caused by paecilomyces varioti , which is not reported from india till date to the best of our knowledge .
a 51-year - old man was on capd had 2 episodes of culture negatibe peritonitis over the period of 2 years .
first episode 2 months after the initiation of capd was treated with empirical antibiotics ( vancomycin and amikacin ) by intraperitoneal route ; second episode 6 months prior to current admission and was treated with the same antibiotics .
he again presented with complaints of diffuse abdominal pain and high grade fever with cloudy pd effluent .
his pd effluent cell count was 3000 cells / mm with 80% polymorphs , gram stain and afb stain were negative , aerobic cultures did not grow any organism .
fungal cultures by sabouraud dextrose agar medium had grown filamentous fungi after 48 hours and microscopically it showed chains of single celled phialoconidia produced in basipetal succession from a phialide .
phialides are swollen at their bases , gradually tapering towards their apices and formed a brush - like penicillus confirming the diagnosis of p. varioti [ figure 1 ] .
accordingly capd catheter was removed , he was initiated on hemodialysis mode amphotericin b was started at 1 mg / kg / day .
he was treated for a period of 4 weeks with a cumulative dose of 1.5 g of amphotericin .
capd catheter reinsertion was done successfully , he is currently on pd and is doing well .
microscopic morphology of paecilomyces varioti showing chains of single celled phialoconidia produced in basipetal succession from a phialide .
phialides are swollen at their bases , gradually tapering towards their apices and may form a brush - like penicillus
in recent years , unusual and  nonpathogenic  fungi like paecilomyces have been increasingly reported as etiologic agents of fungal peritonitis .
paecilomyces are common saprophytic fungi found in soil , silage , and water . they are not usually associated with human infection .
however , some species such as p. varioti , p. marquandii and p. lilacinus are emerging as causative agents of hyalohyphomycosis in the immunocompromised host .
p. varioti have been reported to cause pyelonephritis , endophthalmitis , hairy - cell leukemia , cerebrospinal shunt infection , and prosthetic valve endocarditis .
the most important risk factors for fungal peritonitis are prolonged use of antibiotics and previous bacterial peritonitis episodes . a study by goldie et al .
reported that 65% of fungal peritonitis patients had received broad - spectrum antibiotics within the preceding month , 74% within 3 months , and 87% within 6 months .
our patient presented with fungal peritonitis 6 months after empirical antibiotic therapy for suspected bacterial peritonitis .
several case series reported increased dialysate eosinophils . in other reported cases as well as in our patient , no eosinophilia was found in the dialysate .
the conventional antifungal regimens include fluconazole , amphotericin b , and flucytosine alone or in combination , based on fungal sensitivities .
p. varioti is usually very sensitive to amphotericin b. we used intravenous amphotericin b for our patient who responded dramatically with cumulative dose of 1.5 g.
it can be easily treated with common antifungal agents like amphotericin b which can facilitate catheter reinsertion .
 peritonitis is one of the most common and important complications in patients on continuous ambulatory peritoneal dialysis ( capd ) . 
 fungal peritonitis isreported in 48% of peritonitis episodes . 
 fungal peritonitis due to paecilomyces species is not common . 
 we report a case of capd peritonitis due to p. varioti . 
 we immediately removed the capd catheter and iv amphotericin was administered for 4 weeks along with temporary hemodialytic support followed by successful catheter reinsertion . 
Introduction
Case Report
Discussion
Conclusion