Critical Care: Fellow Case Report Poster - Critical Care III |

Uncommon Cause of Fungemia in a Patient With Renal Cell Cancer FREE TO VIEW

Rashmi Mishra, MD; Kelly Paul, MD; Omesh Toolsie, MD; Puvanalingam Ayyadurai, MD; Muhammad Adrish, MD
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Bronx Lebanon Hospital Center, Bronx, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):254A. doi:10.1016/j.chest.2016.08.267
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SESSION TITLE: Fellow Case Report Poster - Critical Care III

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: The epidemiology of fungal blood stream infections has been changing over the past few years. Due to frequent use of antifungals for prophylaxis and treatment, a shift from Candida albicans to non-albicans Candida species has been noticed over the past two decades.Candida lusitaniae remains an uncommon cause of fungemia.

CASE PRESENTATION: 82-year-old male presented with rapidly progressing severe low back pain without weakness, numbness or loss of bowel or bladder function. On presentation, he was afebrile and hemodynamically stable. MRI lumbar spine was suggestive of metastatic disease and CT abdomen revealed a right renal mass with suspected metastasis to the liver and adrenal glands. A percutaneous biopsy of the right renal mass revealed renal cell carcinoma on pathology. However, six days after biopsy, patient developed hypotension and respiratory distress requiring mechanical ventilation and vasopressors. He was empirically started on intravenous meropenem and vancomycin for presumed septic shock. Intravenous fluconazole was initiated after blood cultures resulted in growth of C.lusitaniae. It was later switched to caspofungin due to worsening transaminitis. Patient’s hemodynamic status improved with discontinuation of vasopressors on day 5 of antifungal treatment and repeat blood cultures resulted negative.

DISCUSSION: C.lusitaniae was first identified in 1959 and is one of the infrequent causes of non albicans invasive candidiasis (IC) accounting for 1.6% of infections. Underlying risks for C. lusitaniae infection include recent surgical procedure and malignancy. Contrary to previous reports in the literature, solid tumor seems to pose a higher risk for IC compared with hematologic malignancy or post-transplant. C. lusitaniae isolates frequently demonstrate poor clinical response to therapy with amphotericin B alone, however are typically susceptible to the triazoles or echinocandins. Mortality rates due C. lusitaniae infection range from 17-40%.

CONCLUSIONS: C.lusitaniae is an emerging but uncommon cause of non albicans IC among immunocompromised patients which is often resistant to Amphotericin B. To our knowledge, this is the first case of C.lusitaniae fungemia described in a patient with renal cell carcinoma.

Reference #1: Pfaller MA, Andes DR, Diekema DJ et al. Epidemiology and Outcomes of Invasive Candidiasis Due to Non-albicans Species of Candida in 2,496 Patients: Data from the Prospective Antifungal Therapy (PATH) Registry 2004-2008. 2014. PLoS ONE 9(7): e101510

DISCLOSURE: The following authors have nothing to disclose: Rashmi Mishra, Kelly Paul, Omesh Toolsie, Puvanalingam Ayyadurai, Muhammad Adrish

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