Case Report of Cardiorenal Syndrome with Ascites and Listeria monocytogenes Peritonitis: The Role of Large-Volume Paracentesis and Albumin Replacement.

BACKGROUND Spontaneous bacterial peritonitis is a common infection in hospitalized patients with ascites, particularly in patients with cirrhosis. Spontaneous bacterial peritonitis is often associated with acute kidney injury. The causative agents of spontaneous bacterial peritonitis are usually gram-negative bacteria, but lately, the prevalence of spontaneous bacterial peritonitis caused by gram-positive bacteria is rising. CASE REPORT In this report, we present the case of a 77-year-old woman with a history of cardiorenal syndrome with ascites and chronic kidney disease who was admitted with diarrhea, fever, and abdominal pain. Ascitic fluid paracentesis revealed spontaneous bacterial peritonitis due to Listeria monocytogenes. During hospitalization, her ascites gradually enlarged and her kidney function deteriorated. The deterioration of kidney function was at least partially attributed to sepsis caused by spontaneous bacterial peritonitis. In addition to proper antibiotic therapy with ampicillin and daily hemodialysis sessions, large-volume paracentesis and albumin infusions were instituted. After 5 days, she showed a fast improvement, the ascites subsided, and her renal function returned to baseline. CONCLUSIONS Spontaneous bacterial peritonitis caused by Listeria monocytogenes is associated with a poor outcome. Acute kidney injury in patients with spontaneous bacterial peritonitis is common and related with a poor outcome. Data about the role of large-volume paracentesis and albumin replacement in patients with spontaneous bacterial peritonitis are still ambiguous. In the literature, all patients with spontaneous bacterial peritonitis due to Listeria monocytogenes who underwent large-volume paracentesis survived.