Background: Rhodococcus equi rarely produced human infection. Most Rhodococcus equi infections this website have been associated with profound impairment of cell-mediated immunity, as seen in patients with AIDS, lymphoproliferative malignancies, and organ transplant recipients on immunosuppressive therapy. Fusarium can cause both superficial infection e.g. keratitis and onychomycosis and invasive infection. However it is an uncommon cause for a fungal PD peritonitis. Methods: This is a case report. Results: A 34-year old ex-mechanic presented with peritoneal dialysis peritonitis secondary

to Rhodococcus equi which was treated with intra-peritoneal Vancomycin, oral ciprofloxacin and concomitant oral nilstat without removal of his Tenchkoff catheter. The patient had declined consent for catheter removal despite slow improvement. His second episode occurred three months later where he had a polymicrobial peritonitis with Fusarium oxysporum and Microbacterium/Cellumonas group. A literature review of previously reported cases of Fusarium peritonitis revealed that this organism usually follows a bacterial infection, relatively antimicrobial resistant and usually requires Tenchkoff catheter DNA Damage inhibitor removal.

All these characteristics were present in our patient. However, to the best of our knowledge, back to back infection with these two unusual organisms has not been described before. Conclusions: This case illustrates the risk of PD peritonitis from unusual infections

in the tropical Top-End of Northern Australia and the risk associated with their acquisition. 286 MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN) IN WALDENSTROM’S MACROGLOBULINEMIA J LING EH, S YEW, D CHALLIS, W JOHNSON Royal Hobart Hospital, Hobart, Tasmania, Australia Background: Membranoproliferative L-gulonolactone oxidase glomerulonephritis (MPGN) is an uncommon cause of glomerulonephritis (reported incidence 0.14–0.93/100,000). The etiology of immune-complex mediated MPGN includes infection, monoclonal gammopathy and autoimmune disease. MPGN associated with monoclonal gammopathy resulting in immunoglobulin deposition is uncommon, especially in Waldenstrom’s macroglobulinemia (WM). We submit a case of an unexpected diagnosis of MPGN in a patient with WM presenting with acute renal failure. Case Report: A 73-year old man with known WM presented with anuric acute renal failure following an elective laparoscopic cholecystectomy. On admission his creatinine was 878 Umol/L with significant hemoproteinuria noted. His serum creatinine pre-cholecystectomy was 138 Umol/L from 79 Umol/L 4 months before. Other investigations showed low C3,C4 levels, cold agglutinins with no evidence of hemolysis and a stable immunoglobulin M (IgM) level on protein electrophoresis. He was hemodialysed and treated for presumed rapidly progressive crescentic glomerulitis with plasma exchange and pulsed intravenous methylprednisolone while awaiting formal biopsy results.