Successful Treatment of Paecilomyces variotii Peritonitis in a Liver Transplant Patient Meltem Polat • Soner Sertan Kara • Anıl Tapısız • Zeliha Demirtas ¸ • Sinan Sarı • Ays ¸e Kalkancı • Hasan Tezer • Buket Dalgıc ¸ Received: 30 June 2014 / Accepted: 18 December 2014 / Published online: 23 December 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract Paecilomyces variotii has previously been reported as a causative pathogen for peritonitis in patients on continuous ambulatory peritoneal dialysis and shown to be usually sensitive to amphotericin B and resistant to voriconazole. We report the first case, to our knowledge, of P. variotii peritonitis in a liver transplant patient, which was unresponsive to initial liposomal amphotericin B (L-AmB) treatment and resolved dramatically after the addition of voriconaz- ole. The present case provides evidence for the clinical and microbiological effectiveness of voriconazole combined with L-AmB in treating P. variotii perito- nitis refractory to initial L-AmB treatment. Keywords Amphotericin B Á Liver transplant Á Paecilomyces variotii peritonitis Á Voriconazole Introduction Paecilomyces species are emerging pathogens that can cause serious infections in immunocompromised patients and occasionally in immunocompetent hosts [1]. Paecilomyces variotii is commonly found as a saprophytic fungus in air and food, and it is also associated with many types of human infections, such as dialysis-related peritonitis, pneumonia, sinusitis, otitis media, endophthalmitis, wound infection, ony- chomycosis, fungemia, endocarditis, and osteomyeli- tis [2]. In the literature, almost all cases of peritonitis due to P. variotii have been reported in patients on continuous ambulatory peritoneal dialysis [3]. How- ever, P. variotii peritonitis in a liver transplant patient is not reported previously. Although P. variotii is susceptible to most antifungal agents including amphotericin B, it has poor susceptibility to vorico- nazole [4]. Herein, we describe a rare case of fungal peritonitis (FP) due to P. variotii in a liver transplant patient, which could not be cured with liposomal amphotericin B (L-AmB) but resolved when vorico- nazole was added to the therapy. Case Report A 16-year-old boy with end-stage liver disease secondary to Wilson’s disease underwent parental living donor liver transplantation on March 2012. The patient received triple immunosuppressive therapy M. Polat (&) Á S. S. Kara Á A. Tapısız Á H. Tezer Department of Pediatric Infectious Diseases, Gazi University School of Medicine, 06500 Bes ¸evler, Ankara, Turkey e-mail: meltemtemizhan@gmail.com Z. Demirtas ¸ Á S. Sarı Á B. Dalgıc ¸ Department of Pediatric Gastroenterology, Gazi University School of Medicine, Ankara, Turkey A. Kalkancı Department of Microbiology, Gazi University School of Medicine, Ankara, Turkey 123 Mycopathologia (2015) 179:317–320 DOI 10.1007/s11046-014-9854-1