Candida tropicalis in Peritoneal Dialysis-related Peritonitis Diagnosed by Matrix-assisted Laser Desorption/ionization Time-of-flight Mass Spectrometry.

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis (PD). Candida tropicalis infections are rarely reported in literature. The authors present the first case of FP with peritoneal abscess due to C. tropicalis in a 22-year-old woman admitted to our hospital with septic shock. Abdominal tomography demonstrated an abscess in peritoneal space and intraluminal bubble appearance in femoral venous and arterial circulation. PD fluid specimens and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis revealed fungus growth of C. tropicalis. Fluconazole therapy was administered accompanied by catheter removal and mechanical ventilation with vasopressor support. The patient recovered after 23 days of hospitalization and was discharged. FP represents high mobility and mortality unless infection source control and appropriate antimicrobial therapy are implemented accompanied by PD catheter removal. The use of MALDI-TOF MS for PD-related peritonitis pathogen identification can promote early identification and appropriate antibiotic therapy, especially in C. tropicalis infection.

Idiopathic nodular glomerulosclerosis and differential diagnosis / Glomerulosclerose nodular idiopática e diagnóstico diferencial

ABSTRACT Introduction: Idiopathic nodular glomerulosclerosis (ING) is a condition that has a vasculopathic glomerular histological pattern. Case presentation: The authors present the case of a 44-year-old Hispanic smoker female with hypertension and peripheral arterial disease who presented nephrotic syndrome for 2 weeks. The patient was diagnosed with ING by percutaneous renal biopsy results, which showed global nodular mesangial matrix expansion, with linear staining accentuation of glomerular and tubular basement membrane for Immunoglobulin G (IgG) and albumin on immunofluorescence. Conclusions: ING is a rare disease with a poor renal prognosis and wide diagnostic approach; we highlight the importance of analyzing every piece of detail together to reach a definitive diagnosis.

RESUMO Introdução: A glomerulosclerose nodular idiopática (GNI) tem um padrão histológico glomerular vasculopático. Apresentação do caso: Os autores apresentam o caso de uma mulher latino-americana, de 44 anos, fumante, com hipertensão e doença arterial periférica; com síndrome nefrótica por 2 semanas. Ela foi diagnosticada com GNI por biópsia renal percutânea, que mostrou expansão generalizada da matriz mesangial nodular, com acentuação de coloração linear na membrana basal glomerular e tubular para imunoglobulina G (IgG) e albumina à imunofluorescência. Conclusões: A GNI é uma doença rara, com mau prognóstico renal, e com necessidade de uma ampla abordagem diagnóstica. Demonstramos aqui a importância de se analisar todos os detalhes em conjunto para realizar um diagnóstico definitivo.

Idiopathic nodular glomerulosclerosis and differential diagnosis.

INTRODUCTION: Idiopathic nodular glomerulosclerosis (ING) is a condition that has a vasculopathic glomerular histological pattern. CASE PRESENTATION: The authors present the case of a 44-year-old Hispanic smoker female with hypertension and peripheral arterial disease who presented nephrotic syndrome for 2 weeks. The patient was diagnosed with ING by percutaneous renal biopsy results, which showed global nodular mesangial matrix expansion, with linear staining accentuation of glomerular and tubular basement membrane for Immunoglobulin G (IgG) and albumin on immunofluorescence. CONCLUSIONS: ING is a rare disease with a poor renal prognosis and wide diagnostic approach; we highlight the importance of analyzing every piece of detail together to reach a definitive diagnosis.