Disseminated Candidiasis in a Man With Alcoholic Cirrhosis

September 14, 2005
Gopi Rana-mukkavilli, MD

A 57-year-old man was brought to the emergency department with fever, chills, and a productive cough of 1-week's duration. He had a history of alcoholism.

A 57-year-old man was brought to the emergency department with fever, chills, and a productive cough of 1-week's duration. He had a history of alcoholism.

Right lower lobe rales, jaundice, and hepatomegaly were present. Significant laboratory data included elevated liver function test results and elevated white blood cell count with bandemia. A chest film was suggestive of right lobar infiltrate. A sputum culture was positive for Klebsiella pneumoniae; blood cultures were negative for microorganisms.

In the ICU, the patient's condition worsened: his blood pressure dropped to 80/60 mm Hg, the fever persisted despite a 3-day course of intravenous ceftriaxone and ticarcillin, and he was placed on mechanical ventilation. Blood cultures were performed again. After the patient had been in the hospital for 7 days, the cultures were positive for Candida albicans. Immediately, antibiotic therapy was discontinued and intravenous amphotericin B for disseminated candidemia was begun. The patient's condition continued to deteriorate; he died of fulminant candidal septicemia.

Gopi Rana-Mukkavilli, MD of New York City states that disseminated candidiasis is found most commonly in immunocompromised hosts, such as this patient who had alcoholic cirrhosis. Disseminated candidiasis is associated with visceral organ involvement; the heart, eyes, liver, and spleen can be affected. Here, the autopsy revealed branching hyphae of C albicans in the myocardium (Figure).

More than half of disseminated candidiasis cases are complicated by candidal myocarditis. Blood cultures may be negative for Candida organisms in 50% of patients with disseminated candidiasis. Histopathologic studies and fungal cultures need to be done to prove the diagnosis.

Amphotericin B is the drug of choice for candidemia. However, even after treatment has begun, mortality remains high. The postmortem examination of this patient confirmed the diagnosis of Klebsiella pneumonia with superimposed disseminated candidemia.