CANDIDA ALBICANS ENDOCARDITIS: A RARE COMPLICATION IN THE BACKGROUND OF RISING FUNGEMIA RATES

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

Journal of General Internal Medicine

Abstract

CASE: Our patient is a 74 year-old male with a past medical history of stage IV pancreatic cancer with metastasis to the lungs and a history of a Whipple procedure, currently on chemotherapy with Fluorouracil and Irinotican. He presented to the hospital with a two-day history of high-grade fevers and rigors at home, and was found to be in septic shock. Patient had AST and ALT levels within normal limits and elevated alkaline phosphatase. He reported no abdominal pain or right upper quadrant tenderness. CT Abdomen demonstrated a possible liver abscess measuring 7.2 by 6.9 cm. Patient was started on broad spectrum antibiotics (Vancomycin and Piperacillin/ Tazobactam), however, he continued to remain intermittently febrile. Interventional radiology-guided drainage of the liver mass yielded 3 mL of serosanguinous fluid. Fluid cultures were positive for Candida albicans. Blood cultures were also positive for Candida albicans. Patient was initially started on anidulafungin and subsequently switched to IV fluconazole for ocular involvement. Transthoracic echocardiogram demonstrated a 2 mm aortic valve vegetation suggestive of endocarditis. His course was complicated by spontaneous bacterial peritonitis due to Enterococcus faecium, requiring daptomycin. Patient was discharged with a 6 week course of fluconazole for Candida albicans fungemia, endocarditis, and endophthalmitis. IMPACT/DISCUSSION: Candida endocarditis is a rare pathology comprising only 1-2% of all endocarditis cases. Despite having low prevalence, the mortality rate for candida endocarditis remains relatively high with figures ranging anywhere between 30-80%. Of concern is the growing incidence of fungemia in the past few years which is putting patients at a higher risk of developing this complication. Common predisposing risk factors include the presence of central line catheters, immunocompromised status, presence of prosthetic valves, open heart surgery, and history of prolonged antibiotic administration. Our case presents a rare complication of Candida albicans fungemia, originating from hepatic candidiasis. Given the exponential rise in fungemia rates and the high mortality rate of Candida albicans infective endocarditis, it is important for clinicians to keep this diagnosis on their differential and order appropriate testing so that treatment can be initiated in a timely manner. CONCLUSION: Candida infections should be considered in the workup of patients presenting with sepsis, especially in patients with gastroenterological malignancies. Candida endocarditis is a serious sequela of candidemia and is associated with a high mortality rate.

Volume

37

Issue

Suppl 2

First Page

S432

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