Abstract: Objective  To explore the diagnosis and treatment of a rare Benacovirus infection in a patient with peritoneal dialysis-associated peritonitis.  Methods  A case of refractory peritoneal dialysis-related peritonitis caused by Benacovirus infection was retrospectively analyzed, and the related literature was reviewed.  Results  The pathogen of Benacovirus was identified by high-throughput sequencing of MetaCAP microbial nucleic acids from patient's peritoneal drainage fluid. Continuous peritoneal lavage and drainage using double-lumen tubes combined with oral administration of doxycycline gradually clarified the peritoneal drainage fluid and reduced white blood cell counts in the fluid. Follow-up for 2 months after removal of the drainage tube showed no recurrence.  Conclusion  When conventional methods fail to detect the pathogen, MetaCAP sequencing can be helpful to provide etiological evidence and treatment strategy for the peritoneal dialysis-associated peritonitis. Coxiella burnetii is a rare pathogen causing peritoneal dialysis-associated peritonitis, requiring prompt recognition and appropriate treatment.

Key words: Benaxx infection, Refractory peritonitis, Peritoneal dialysis-associated peritonitis