Acute Q fever presenting as peritoneal dialysis-associated refractory peritonitis: A case report

OBJECTIVES: Peritoneal dialysis-related peritonitis (PDAP) is a common and severe complication of peritoneal dialysis (PD), and it constitutes a major cause of PD treatment failure and patient mortality. The most common organisms causing PDAP are Staphylococcus aureus, Enterococcus spp, Escherichia. coli, and Pseudomonas aeruginosa. Although conventional anti-infective therapy can lead to the recovery of most cases, 10-20% of patients still progress to refractory peritonitis (RP). Query fever (Q fever), a zoonotic disease, caused by Coxiella burnetii, is an infectious disease that has long been considered a rare and regionally restricted disease. It can be responsible for hepatitis, pneumonia, endocarditis, endovascular infections, and so on. However, Q fever is rarely considered a cause of PDAP. Herein, we report a case of Q fever presenting as peritoneal dialysis-related refractory peritonitis (PDRP). METHODS: We retrospectively analyzed the clinical manifestations, diagnostic workup, and therapeutic management of a 29-year-old male peritoneal dialysis patient diagnosed with Coxiella burnetii-induced PDRP. RESULTS: The patient received a combination therapy regimen based on doxycycline, hydroxychloroquine, and rifampicin, and was discharged after achieving clinical improvement. CONCLUSION: This case highlights the possibility of Coxiella burnetii-induced PDRP and emphasizes that appropriate prolongation of the initial treatment course is crucial for improving clinical outcomes in immunocompromised patients.