(1) Background: Chronic kidney disease (CKD) increases the susceptibility to the presence of herpes zoster (HZ). Little is known about the risk factors of HZ in CKD patients; (2) Methods: This is a case-control study. CKD patients diagnosed with HZ between January 2015 and June 2021 in a tertiary hospital were identified. One age- and gender- matched control was paired for each case, matched to the date of initial HZ diagnosis. Conditional multiple logistic regression was used to evaluate the risk factors associated with the presence of HZ; (3) Results: Forty-seven HZ patients and controls were identified. In general, about 73.40% (69 out of 94) patients were classified at IV to V stages of CKD. Immunosuppressive agents (p = 0.0012) and dialysis therapy (p = 0.021) were reported more frequently in the HZ cohort. Compared with the control group, the total white cell count and lymphocyte count were significantly lower in the HZ group (p value of 0.032 and 0.003, respectively). The conditional logistics regression model revealed that previous immunosuppressants administration (odds ratio: 10.861, 95% CI: 2.092~56.392, p = 0.005) and dialysis therapy (odds ratio: 3.293, 95% CI: 1.047~10.355, p = 0.041) were independent risk factors of HZ in the CKD population; (4) Conclusions: Dialysis and immunosuppressants therapy were associated with greater risk of HZ disease in CKD patients. Further guideline may highlight the necessity of zoster vaccine for patients with CKD, who undertake associated treatment.

Introduction: Lautropia mirabilis is a rare cause of peritonitis associated with peritoneal dialysis-associated peritonitis (PDAP). We report the first documented case of PDAP caused by coinfection with L. mirabilis, cytomegalovirus (CMV), and Epstein-Barr virus (EBV). Case Presentation: A 67-year-old woman with end-stage renal disease secondary to polycystic kidney disease, on continuous ambulatory peritoneal dialysis for 3 years, developed PDAP. Initial peritoneal dialysis effluent (PDE) culture grew Streptococcus salivarius, and symptoms resolved with treatment. However, she was readmitted 2 days later with recurrent PDAP. Despite 18 days of empirical antibiotic therapy and repeated negative PDE cultures, the patient’s symptoms persisted. Upon her transfer to our hospital, PDE white blood cell (WBC) count was 110 × 106/L. Targeted next-generation sequencing (tNGS) of the PDE performed on day one detected L. mirabilis (16,929 reads), CMV (944 reads), and EBV (285 reads). Therapy with intravenous moxifloxacin, intraperitoneal gentamicin, and oral ganciclovir led to rapid WBC decline and clinical improvement within 48 h. After 1 week of inpatient monitoring, the patient was discharged with a 2-week course of oral moxifloxacin. At the 2-week follow-up, the patient was asymptomatic with normal PDE WBC counts. Conclusion: Conventional culture methods may fail to detect uncommon pathogens, such as L. mirabilis. Culture-negative PDAP often necessitates empirical antibiotic therapy, carrying a high risk of failure and increased healthcare costs. This case suggests that tNGS could be used as a complementary diagnostic tool in selected cases of refractory, culture-negative PDAP, potentially aiding the identification of pathogens and guiding therapy.