Spontaneous Fungal Peritonitis: A Rare Complication of Ascites Secondary to Right Heart Failure: A Case Report

•Spontaneous fungal peritonitis (SFP) is an infection defined as a neutrophil count (> 250 cells/mL) in the ascitic fluid with the evidence of positive fungal culture (1) while excluding other intra-abdominal infections. SFP is not as common as spontaneous bacterial peritonitis and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. (1,2) . The common risk factors that have shown to increase the mortality for SFP include hepatorenal syndrome, patient on SBP prophylaxis, elevated APACHE II scores on admission, and elevated lactate levels (2,3) . Candida albicans and Candida glabrata are the two most common fungal pathogens responsible for SFP in the cirrhotic population (4) . Spontaneous fungal peritonitis is an uncommon phenomenon occurring in a patient with cardiogenic ascites because of high protein content which is generally considered a low risk for infections. Signs and symptoms are indistinguishable from SBP, which may include abdominal pain, distension, guarding, fever and/or tachycardia. We present the second known case of spontaneous fungal peritonitis occurring on the background of cardiac cirrhosis, that was confirmed with fungal cultures growing Candida glabrata and was successfully treated with appropriate antifungal agents.