P4211 - Saccharomyces Cerevisiae Peritonitis in HIV Patient with PEG Tube

Muhammad Hussain, MD¹, Daniel Armanious, ², Anthony Armanious, ², Fnu Marium, MD³, Saraswathi Lakkasani, MD¹, Yatinder Bains, MD⁴, Theodore DaCosta, MD⁵, Jihad Slim, MD^5
1Saint Michael's Medical Center, New York Medical College, Newark, NJ; ²Seton Hall Preparatory School, Newark, NJ; ³Jinnah Sindh Medical University, Harrison, NJ; ⁴Saint Michael's Medical Center, Newark, NJ; ⁵Saint Michael's Medical Center, Newark, NJ

Introduction: Saccharomyces cerevisiae is a strain of yeast commonly used for breadmaking. There are published cases of peritonitis caused by yeast in ambulatory peritoneal dialysis patients. We are reporting first case of peritonitis associated with PEG tube in the HIV patient, status post closure of gastrocutaneous fistula using the over-the-scope Padlock clip.

Case Description/Methods: 64 YO F with PMH STEMI, CHF,CVA, HIV, prediabetes, substance abuse came to ED with c/o altered mental status and abd pain. She was admitted twice in last 3 months for STEMI and CHF. She also had percutaneous endoscopic gastrostomy (PEG) tube placement during last admission. She smokes crack cocaine. She was hypotensive and mild tachypnic. Heart rate was normal since she was on beta blocker. She was febrile with Tmax of 100.4 F. Examination revealed tender abdomen with foul smelling fluid leaking from PEG tube site and PEG tube site was indurated with some erythema and bumper was lightly attached to skin. CT abdomen showed moderate ascites with extensive mesenteric and omental fat stranding. She was admitted in the medical intensive unit (MICU) for sepsis associated encephalopathy with shock secondary to peritonitis. Labs were significant for leukocytosis of 14.30 (neutrophil 12.8), BUN/creatinine 48/1.9, albumin 1.6 g/dl. LFTs were normal. Fungitell was 404 pg/ml. Paracentesis was done with removal of 1800 ml cloudy ascitic fluid. Workup showed SAAG < 1.1, WBC 5100 (neutrophil 80%). Culture of the ascitic fluid grew Saccharomyces cerevisiae and Escherichia coli (E. coli). PEG tube was removed, and patient was started on piperacillin/tazobactam followed by ceftriaxone since E. coli was sensitive to ceftriaxone. She was also started on mycamine after fungal culture grew saccharomyces. Fungitell was 404 pg/ml which trended down while being on mycamine. Due to persistent leakage from old PEG tube site, padlock steris clip was applied endoscopically. She passed away in next couple of days due to her underlying comordities.

Discussion: Mechanisms by which S. cerevisiae infection can occur are either translocation from GI tract or breach in the skin barrier, primarily in setting of indwelling intravascular devices. It requires both dysfunction of intestinal barrier and large enteral fungal burden to cause systemic infection. In this immunosuppressed patient (HIV with acquired immunodeficiency syndrome AIDS) colonized by S. cerevisiae, PEG tube insertion causes disruption of intestinal barrier and leads to peritonitis.


Disclosures:


Muhammad Hussain, MD¹, Daniel Armanious, ², Anthony Armanious, ², Fnu Marium, MD³, Saraswathi Lakkasani, MD¹, Yatinder Bains, MD⁴, Theodore DaCosta, MD⁵, Jihad Slim, MD⁵. P4211 - Saccharomyces Cerevisiae Peritonitis in HIV Patient with PEG Tube, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.