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Refractory peritonitis is defined as failure of effluent clearance after five days of appropriate antibiotics in peritoneal dialysis patients. It is a reason for peritoneal dialysis failure. Although fungal and mycobacterial peritonitis are uncommon (approximately 15% of the cases), they are difficult to diagnose and treat. Herein, we report a case of peritonitis caused by two unusual pathogen, Candida guilliermondii and Mycobacterium avium complex, which probably reached the peritoneum via the vaginal route, in a long-term peritoneal dialysis patient with malnutrition. Rare organisms should be considered as causative agents in refractory peritonitis cases. [ABSTRACT FROM AUTHOR]

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with metabolic disorders and is an important factor in extrahepatic complications. The aim of the present study was to determine the development of extrahepatic malignancy in patients with NAFLD. MATERIALS & METHODS: This was a single-center, retrospective cohort study. Between January 2001 and January 2020, a total of 1099 patients had been diagnosed with NAFLD, who were followed for at least six months were included into the study. The diagnosis of NAFLD was made based on biochemical, radiological and histological when available. The median follow-up period was months 62.3 months (interquartile range: 23.3-128.0 months).. RESULTS: The mean age was 51.1±11.0 years. Female gender was predominant (57%). Of the 1099 patients, 19,7% had diabetes mellitus, 29,5% had hypertension. Ninety and three patients (8.5%) had cirrhosis. Extrahepatic malignancy was developed in 54 NAFLD patients during the follow-up period, whereas hepatocellular carcinoma developed in 10 patients. Forty and six solid organ malignancies and 11 hematological malignancies was developed. Two different malignancy was developed in three patients. Female breast cancer was more commonly developed (28%, 16/57), followed by thyroid cancer (19%), lymphoma (12%) and lung cancer (11%). Extrahepatic malignancy development was more common in older patients (54.4±8.4 years vs. 50.9±11.1 years, p=0.038), in female patients (n=40 6.4% vs n=14, 2.9%, p=0.01), baseline high GGT level (72.1±68.0 U/L vs. 60.7±80.2 U/L), p=0.038). With logistic regression analysis, the development of extrahepatic malignancy was significantly associated with female gender (adjusted odds ratio (OR): 1.92, p=0.05). In conclusion, the based on the present study, NAFLD is a risk factor for extrahepatic malignancies. [ABSTRACT FROM AUTHOR]