Black Specks in Dialysis Fluid: An Unusual Case of Peritonitis in a Pediatric Patient on Peritoneal Dialysis

A 13-year-old boy resumed peritoneal dialysis after the loss of a deceased donor renal transplant but was maintained on mycophenolate mofetil and monthly infusions of intravenous immunoglobulin to reduce his panel reactive antibody level. He developed low-grade fever, cloudy fluid, and abdominal pain without peritoneal signs. His mother reported seeing some black "flakes" in his effluent. He was admitted and treated for presumed bacterial peritonitis twice with neither bacterial nor fungal growth on cultures. He received empiric antibiotics and appeared to respond partially. The patient remained asymptomatic with little abdominal pain, but had progressive difficulties with drainage. A black "speck" was obtained and identified as Curvularia. The peritoneal dialysis catheter was removed, and he was treated with both intravenous and intraperitoneal amphotericin B. This is the second case of peritonitis caused by Curvularia in a pediatric peritoneal dialysis patient reported in the literature.