Listeria monocytogenes (LM) is one of the rare microorganisms causing peritonitis in peritoneal dialysis (PD) patients. We report a sporadic case of peritonitis caused by LM in a young female PD patient with lupus receiving corticosteroid therapy, who presented with abdominal pain, cloudy PD effluent, nausea, and conjunctivitis. The effluent showed a high PD effluent white cell count and monocytosis, and gram staining showed gram-positive bacilli in single or short chains and PD effluent culture grew LM. She was treated successfully with beta lactum antibiotics. LM peritonitis should be suspected if a patient presents with gram-positive bacilli and monocytosis in dialysis effluent.

Even in renal failure patients on PD, introduction of icodextrin has been shown to decrease extra cellular water and improve hemodynamics. Icodextrin offers several advantages:■ It offers more physiologic ultrafi ltration.■ Euvolemia can be maintained without additional dextrose exchanges.■ Single exchange is easy on lifestyle and decreases risk of touch contamination and hence incidence of peritonitis. Neither of the patients required hospitalization for either cardiac or dialysis related issues, as compared to multiple admissions in the preceding year. FUTURE PROSPECTS■ Comparison of PD versus standard therapy and ultrafi ltration devices to demonstrate survival benefi t with less morbidity and costs.■ Is there preservation of renal function with PD as compared to standard medical therapy? Will this delay the progression of heart failure by interrupting cardiorenal syndrome?■ What will be the effect of biocompatible PD solution with associated less infl ammation on heart failure pathogenesis?■ Large trials with long-term follow-up looking at the effect of PD on progression of heart failure.