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Black mold in the bag room: First case of Arthrocladium tropicale peritonitis in a peritoneal dialysis patient

Summary

An 82-year-old dialysis patient developed an unusual infection caused by a black mold called Arthrocladium tropicale, which had never been documented in humans before. The infection was traced to poor storage conditions and ant infestations near the patient’s dialysis supplies in Thailand during rainy season. Doctors identified the rare fungus using molecular genetic testing and treated it successfully with antifungal medication combined with removal of the dialysis catheter. This case highlights the importance of keeping dialysis equipment in clean, dry environments and preventing pest access to prevent serious infections.

Background

Arthrocladium tropicale is a melanized filamentous fungus previously isolated from decaying wood and ant colonies in tropical environments but has not been documented as a cause of human disease. This case reports the first documented infection of A. tropicale in a peritoneal dialysis (PD) patient.

Objective

To describe the clinical presentation, diagnosis, and treatment of the first documented case of A. tropicale-associated peritoneal dialysis peritonitis and identify environmental risk factors for contamination.

Results

The patient presented with atypical peritonitis features including low effluent cell count (36 cells/mm³) but elevated neutrophil proportion (78%). Black particulate matter was observed in the PD catheter lumen, and rDNA sequencing confirmed A. tropicale with 98.8% identity. The isolate was resistant to posaconazole but susceptible to amphotericin B. Treatment with intravenous amphotericin B combined with catheter removal resulted in full clinical recovery with no recurrence at 10-month follow-up.

Conclusion

This first documented case of A. tropicale peritonitis in a human demonstrates the importance of molecular diagnostics for identifying rare non-sporulating fungi and highlights the critical role of strict environmental control and pest prevention in PD settings, particularly in tropical climates where fungal and insect proliferation is likely.
  • Published in:IDCases,
  • Study Type:Case Report,
  • Source: PMID: 41079882, DOI: 10.1016/j.idcr.2025.e02383
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