This study highlights a rare instance of Pseudomonas aeruginosa-associated green nail syndrome occurring alongside a peritoneal dialysis (PD) exit site infection (ESI). The patient was successfully treated with both oral and topical antibiotics, notably without the need to remove the PD catheter. This case underscores the significance of including nail assessments in the evaluation of ESI in PD patients, suggesting that such assessments could be crucial for early detection and treatment of infections, potentially preventing more severe complications.