We report a case of spontaneous fungal peritonitis in a patient with cirrhosis. A 70-year-old woman with cirrhosis secondary to autoimmune hepatitis was admitted with fever and abdominal distention. Paracentesis revealed neutrocytosis, and despite appropriate antibacterial coverage, no clinical improvement was noted and the ascitic fluid white cell count increased on repeat paracentesis. Two consecutive ascitic fluid cultures grew Candida glabrata, and antifungal therapy with amphotericin was initiated, pending sensitivity of the isolate. Because of worsening renal function, amphotericin was discontinued and itraconazole was started, as sensitivity of the isolate was then available. Antifungal therapy resulted in resolution of ascitic fluid neutrocytosis and culture negativity. However, the patient's renal function continued to deteriorate, necessitating hemodialysis. Despite multiple courses of antibiotics, she died of fulminant sepsis and multiorgan failure.
From the Divisions of Gastroenterology & Infectious Diseases, Department of Medicine, Our Lady of Mercy University Medical Center, New York Medical College, Bronx, New York, U.S.A.
Submitted September 2, 1999.
Accepted January 10, 2000.
Address correspondence and reprint requests to Dr. Marilou Corpuz, Department of Medicine, Our Lady of Mercy Medical Center, 600 East 233rd Street, Bronx, NY 10466, U.S.A.