A case of peritoneal dialysis-associated peritonitis caused by Rhodococcus pyridinivorans

BACKGROUND: Rhodococcus infections are exceedingly rare and largely reported in immunocompromised hosts, with no consensus on optimal therapy due to limited evidence. CASE PRESENTATION: This article reports for the first time a case of peritoneal dialysis-associated peritonitis caused by Rhodococcus pyridinivorans in a patient with diabetic nephropathy. The dialysate leukocyte count declined substantially with combination antimicrobial therapy, but complete normalization occurred only after replacing icodextrin with a glucose-based dialysate. CONCLUSIONS: These findings support the use of combination regimens and emphasize the need to consider icodextrin-associated sterile peritonitis when dialysate abnormalities persist despite appropriate antimicrobial treatment.