A 20-year-old man on automated peritoneal dialysis developed vague abdominal symptoms, weight loss and declining ultrafiltration. Repeated dialysate cultures, acid-fast staining and molecular tests were negative despite mononuclear-predominant leukocytosis. Contrast CT identified peritoneal nodules, CT peritoneography showed a trapped dialysate pocket, and targeted biopsy demonstrated necrotising granulomatous inflammation. Tissue culture grew M. kansasii resistant to rifampicin, moxifloxacin and ciprofloxacin.
Key findings
- Susceptibility-guided isoniazid, azithromycin, ethambutol and amikacin plus catheter removal were followed by clinical and inflammatory improvement within six weeks. Treatment was curtailed after an out-of-hospital cardiac arrest in a patient with severe cardiomyopathy, so definitive microbiological cure could not be established.
Why this matters globally
The report alerts dialysis services that rare indolent infection can persist despite negative effluent tests and proposes an imaging-to-biopsy diagnostic pathway. Its international relevance is educational, but a single case cannot define diagnostic criteria or standard treatment.
Thai researcher contribution
Thailand-linked authors are affiliated with Chulalongkorn University, the Thai Red Cross Society and King Chulalongkorn Memorial Hospital. The team contributed the diagnostic work-up and clinical case documentation reported in the article.
Limitations to consider
This is one uncontrolled case with severe cardiac comorbidity. Follow-up ended before treatment completion, preventing confirmation of cure. It cannot estimate treatment effectiveness, establish causality or justify routine CT peritoneography for all patients.