Candida lusitaniae Peritonitis Associated With Nonsurgical Pneumoperitoneum: A Case Report Exploring a Causal Relationship or Coincidence.

Pneumoperitoneum is classically associated with perforated abdominal viscus and typically prompts emergent surgical evaluation and intervention. However, a small subset of patients present with nonsurgical pneumoperitoneum in the absence of gastrointestinal perforation, creating a significant diagnostic and management challenge for clinicians. Distinguishing surgical from nonsurgical causes is particularly difficult when patients demonstrate signs of peritonitis, as the presence of abdominal tenderness, guarding, or systemic inflammatory findings may strongly suggest bowel perforation despite negative imaging or operative findings. In rare cases, infectious etiologies may further complicate the clinical picture. Candida lusitaniae peritonitis is exceptionally uncommon outside the setting of peritoneal dialysis or significant immunocompromise and has rarely been described in association with nonsurgical pneumoperitoneum. We report an unusual case of pneumoperitoneum without gastrointestinal perforation complicated by C. lusitaniae peritonitis in an immunocompetent patient following recent suprapubic catheter placement. Fungal peritonitis due to C. lusitaniae is exceptionally uncommon, especially in patients without a history of peritoneal dialysis, abdominal surgery, or significant immunocompromise. Recognition of these atypical presentations is important to avoid diagnostic delays and to guide appropriate medical and surgical management strategies.