Spontaneous bacterial peritonitis due to Edwardsiella tarda in an immuno-compromised dialysis patient: A case report and review of literature

BACKGROUND Edwardsiella tarda (E. tarda ) belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish, but is also capable of infecting humans. Extraintestinal infections occur in patients with certain risk factors, including immunocompromised status. We recently diagnosed a case of spontaneous bacterial peritonitis (SBP) due to E. tarda in an immuno-compromised dialysis patient. CASE SUMMARY Patient was a 55-year-old male, with a history of diabetic nephropathy being treated with hemodialysis three times a week. He was referred to our hospital due to an increased volume of ascites, and blood examination revealed increased inflammatory reaction. At our emergency department, he developed fever, disturbance of consciousness, abdominal distension, and abdomen-wide pain. In addition, a dialysis shunt was confirmed in his right forearm, and the shunt site showed no signs of inflammation. No wounds were confirmed on or in his body. A blood examination revealed increased values of white blood cells, C-reactive protein, and creatinine. Plain chest and abdominal computed tomography scanning revealed increased ascites volume. Abdominal paracentesis was performed and a Gram stain revealed Gram-negative bacillus. These findings prompted diagnosis of SBP. The patient was admitted and treated with cefmetazole, causing fever resolution and symptom improvements. Later, E. tarda was identified in ascites culture. The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization. The antibiotic was terminated after 14 days of treatment. SBP in this case may have developed from chronic renal failure and diabetes mellitus. CONCLUSION We report the first known case of SBP due to E. tarda in an immuno-compromised dialysis patient.