Abstract
Chronic disseminated candidiasis (CDC) is a severe complication with high morbidity and mortality in patients with hematological malignancies who have undergone chemotherapy. Blood or sterile liver biopsy cultures are negative due to recurrent empirical antifungal therapy. With the escalating resistance to azole-based antifungal drugs in infection by Candida species, pathogen identification is becoming increasingly important for determining definitive diagnosis and treatment strategy. In this case report, we present, for the first time, diagnostic confirmation of a culture-negative CDC case with Candida tropicalis infection using a combination of metagenomics next-generation sequencing and calcofluor white staining.
Highlights
Chronic disseminated candidiasis (CDC; known as “hepatosplenic candidiasis”) is a unique manifestation of invasive candidiasis
The antifungal agent was changed from VRC to CAP due to suspicion of CDC (Figure 2)
The results showed 55 total reads of C. tropicalis, accounting for 98.21% total fungal reads which was sentenced as responsible pathogen in accordance with other clinical evidences
Summary
Chronic disseminated candidiasis (CDC; known as “hepatosplenic candidiasis”) is a unique manifestation of invasive candidiasis. Computed tomography (CT) of the abdomen showed multiple low-density lesions in the liver, spleen, and kidneys in day-28. Caspofungin (CAP) from day-18 to day-28 and voriconazole (VRC) from day-28 to day-38 were used as antifungal therapy after a positive result for the BDG test on day-18 (Figure 1). The antifungal agent was changed from VRC to CAP due to suspicion of CDC (Figure 2) Her condition did not improve significantly, and recurrent fever persisted (Figure 2). The patient symptoms were alleviated with a decrease of CRP level and white blood cell count (Figure 2). Her body temperature remained normal and we discontinued use of DXM (Figure 2). The patient was transferred to local hospital to continue antifungal therapy and was suggested to follow-up with CT scan every 2 months
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