P252 A rare case of fungal liver abscess in an immunocompetent patient from India

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo report a case of hepatic abscess caused by Candida albicans, which is a less common cause of hepatic abscesses in a non-onco-hematologic population. Fungal infections represent <2% of the total isolates in pus from hepatic abscesses in patients without onco-hematologic malignancies.MethodsA 68-year-old adult male diabetic patient came with complaints of fever with chills and rigor and right upper abdominal pain and yellowish discoloration of eyes and urine. His LFT, PT-INR, RFT were deranged. CBC report shows anemia and Leukocytosis. His CECT showed irregular multiseptated hypodense lesions in segment V, VI, VII of liver. Direct and mycological and bacterial culture examination was performed.ResultsDirect examination of pus sample showed budding yeast cells with pseudohyphae and in SDA culture at 37°C it showed white pasty colonies. The species was identified by VITEK 2 system as C. albicans. The MICs obtained of antifungals were (ug/mL): fluconazole (≤0.5); voriconazole (≤0.12); caspofungin (≤0.12); micafungin (≤0.06); amphotericin b (1); flucytosine (≤1). The patient was started on caspofungin and improved symptomatically. Then oral fluconazole was started and continued until the resolution of lesion on imaging during the follow-up.DiscussionColonization of the gastrointestinal tract is thought to be the main origin of the dissemination of Candida; neutropenia facilitates the spread of Candida from the gastrointestinal tract to the liver. The likely source of infection is GIT in this case.ConclusionWe describe a case of fungal liver abscess in an immunocompetent patient caused by Candida albicans which was successfully treated with caspofungin.