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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 infection caused by a rare black mold called Arthrocladium tropicale, which had never been documented in humans before. The infection came from poor environmental conditions including moisture and ant infestations near the patient’s dialysis supply storage area. Doctors identified the fungus using genetic testing and treated it successfully with antifungal medication combined with removal of the dialysis catheter. This case shows how important it is to keep dialysis equipment areas clean and dry to prevent rare infections.

Background

Arthrocladium tropicale is a melanized filamentous fungus previously isolated from decaying wood and tropical environments but has not been linked to human disease until now. This case represents the first documented human infection caused by A. tropicale in a peritoneal dialysis patient.

Objective

To report and characterize the first case of Arthrocladium tropicale peritonitis in a peritoneal dialysis patient, including diagnosis, treatment, and environmental factors contributing to contamination.

Results

Molecular barcoding revealed 100% query coverage with 98.8% sequence identity to A. tropicale via LSU rDNA sequencing and 95.6% identity via ITS sequencing. The isolate demonstrated resistance to posaconazole (MIC = 2 µg/mL) but susceptibility to amphotericin B (MIC = 0.5 µg/mL). Treatment with intravenous amphotericin B (1 mg/kg/day for two weeks) combined with catheter removal resulted in full recovery with no recurrence at 10-month follow-up.

Conclusion

This first documented case of A. tropicale peritonitis expands the pathogenic spectrum of environmental fungi in peritoneal dialysis. The case underscores the importance of molecular diagnostics for identifying rare, non-sporulating fungi and highlights critical environmental control measures including pest prevention and proper storage conditions to prevent fungal contamination in PD settings.
  • Published in:IDCases,
  • Study Type:Case Report,
  • Source: PMID: 41079882, DOI: 10.1016/j.idcr.2025.e02383
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