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Timely diagnosis and management of Quambalaria cyanescens-induced peritoneal dialysis peritonitis: A rare case highlighting the role of galactomannan testing

Summary

A 53-year-old man on peritoneal dialysis developed a rare fungal infection caused by Quambalaria cyanescens. Doctors used a special blood test (galactomannan testing) to quickly identify it as a fungal infection rather than a bacterial one, leading to timely removal of his dialysis catheter on day 5. After treatment with antifungal medications, he recovered completely with no relapses over two years of follow-up. This case shows the importance of proper hygiene during dialysis and using advanced diagnostic tools for rare infections.

Background

Fungal peritonitis in peritoneal dialysis (PD) patients is rare, representing 1-3% of cases, but is associated with significantly higher morbidity and mortality. Quambalaria cyanescens is an exceedingly uncommon basidiomycete fungus with only one previously documented case of PD-associated peritonitis. This case represents a clinical challenge requiring advanced diagnostic approaches.

Objective

To report the second documented case of Quambalaria cyanescens-induced PD peritonitis and demonstrate the pivotal role of galactomannan testing in guiding timely catheter removal and treatment initiation. The case emphasizes adherence to 2022 ISPD Peritonitis Guidelines for optimal patient outcomes.

Results

Positive galactomannan index in PDE (0.65) and serum (0.98) prompted early catheter removal on day 5. Molecular sequencing confirmed Q. cyanescens. The isolate was susceptible to amphotericin B and isavuconazonium but resistant to azoles and echinocandins. Treatment with amphotericin B followed by voriconazole achieved symptom resolution with no relapses during two-year follow-up.

Conclusion

This case demonstrates the critical utility of galactomannan testing in identifying fungal peritonitis and guiding timely catheter removal. Adherence to 2022 ISPD guidelines, integration of molecular diagnostics, early targeted antifungal therapy, and patient education on sterile PD techniques are essential for favorable outcomes in rare fungal PD infections.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40041546, DOI: 10.1016/j.mmcr.2025.100697
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