Peritoneal dialysis-associated polymicrobial peritonitis with slow onset after root canal treatment: the first case and review of the literature.

backgroundPeritoneal dialysis (PD)-associated peritonitis is linked to an increased risk of mortality and catheter removal, with a higher incidence of these risks observed in polymicrobial peritonitis compared with single-organism infection. In PD patients, invasive procedures can cause peritonitis, typically within 7 days, through transient bacteremia. Although dental procedures are widely recognized as a cause of transient bacteremia, only a limited number of cases involving PD-associated peritonitis after dental procedures, and no cases of polymicrobial peritonitis, have been reported. CASE PRESENTATION: A 60-year-old man undergoing PD presented with acute low abdominal pain, and was diagnosed with PD-associated peritonitis caused by Streptococcus (S.) oralis, S. vestibularis, and S. salivarius. The polymicrobial peritonitis was successfully treated with antibiotics and catheter removal was not required. Medical consultation after admission revealed a history of root canal treatment for dental caries in the right maxillary second molar, and a dental examination during hospitalization confirmed its success.

conclusionsWe report a case of PD-associated peritonitis caused by co-infection with three species of viridans group streptococci, which developed 9 days after the completion of root canal treatment. This case history suggests that it may be important to carefully observe patients until 10 days after dental procedures, because of the slow onset of peritonitis following such procedures.