S5088 An Uncommon Culprit in a Common Setting: Candida glabrata Spontaneous Fungal Peritonitis in Cirrhosis

Introduction: Spontaneous fungal peritonitis (SFP) is characterized by a fungal infection in ascitic fluid without any evident intra-abdominal source of infection or underlying malignancy. Factors linked to in-hospital mortality in SFP include advanced liver cirrhosis (LC), high Child-Pugh and MELD scores, use of antibiotic prophylaxis, occurrence of hepatorenal syndrome (HRS), and low protein levels in ascitic fluid. Antibiotics disrupt regular gut flora and lead to fungal overgrowth leading to their translocation despite being larger than bacteria. Here we present a case of Candida glabrata peritonitis in advanced LC patients. Case Description/Methods: Patient is a 45-year-old man with decompensated alcoholic liver cirrhosis presented with gradually worsening abdominal distension and pain. He was diagnosed with spontaneous bacterial peritonitis twice before and is on prophylaxis with ciprofloxacin at home. Vitals were stable on admission. Physical examination is remarkable for mild generalized tenderness with grossly distended abdomen. He was found to be in AKI, hyponatremia and MELD of 39. He underwent paracentesis with 5700 ml of straw colored hazy fluid removed and was started on ceftriaxone for SBP prophylaxis. Blood cultures are negative. Fluid analysis showed a total cell count of 260 with 71% polymorphonuclear leukocytes and ascitic fluid growing yeast. He was then started on micafungin, ascitic fluid cultures grew candida albicans and was later switched to fluconazole for a total of 4 weeks’ duration. Therapeutic paracentesis was done a few weeks later in which ascitic fluid cultures were negative. Discussion: Candida species is associated with a severe outcome when manifested with peritonitis. High mortality and poor prognosis is associated with SFP because of its delayed detection in ascitic fluid cultures, absence of clear clinical symptoms, low clinical suspicion, and postponed initiation of antifungal treatment and resistance as well. Additional research is essential to deepen our understanding of SFP and enhance treatment outcomes using currently available antifungal therapies.