Salivary gland infection with Candida tropicalis: antibiotic suppression therapy resulting in selection of uncommon pathogens

Joffrey Van Prehn,M Van Seijen,S Van Weert,A E Budding,A J Van Nieuwenhuizen

doi:10.1099/jmmcr.0.000064

Abstract

Introduction: Candida infection of the salivary glands is extremely rare, and a parotid gland infection with Candida tropicalis in an immunocompetent patient has, to the best of our knowledge, never been described before. Case presentation: A 76-year-old male with known bilateral oncocytic parotid lesions and antibiotic suppression therapy for a vascular endograft infection presented with fever and a tender red mass in the left parotid region. Although a bacterial infection of the parotid gland was suspected at first, cultures of parotid cyst aspirate yielded C. tropicalis. Once the Gram stain indicated the presence of yeast cells, fluconazole therapy was initiated. Follow-up after 3 weeks showed resolution of the infection and antifungal therapy was ceased. Conclusions: With increasing and widespread antibiotic use, this case underlines the emergence of uncommon pathogens by antibiotic selection pressure. This shift in causative pathogens will not only result in an increase in Candida infections at known body sites but will also lead to infection of less common anatomical sites. Clinicians should recognize this trend and adjust their differential diagnosis accordingly.

Highlights

IntroductionCandida infection of the salivary glands is extremely rare, and a parotid gland infection with Candida tropicalis in an immunocompetent patient has, to the best of our knowledge, never been described before
Candida infection of the salivary glands is extremely rare, and a parotid gland infection with Candida tropicalis in an immunocompetent patient has, to the best of our knowledge, never been described before.Case presentation: A 76-year-old male with known bilateral oncocytic parotid lesions and antibiotic suppression therapy for a vascular endograft infection presented with fever and a tender red mass in the left parotid region
Candida spp. are known colonizers of the oropharynx, salivary gland infection with Candida spp. is extremely rare: only a handful of such cases have been described in the literature

Summary

Introduction

Infection of the parotid gland most commonly has a viral (e.g. mumps virus) or bacterial origin, the latter often evoked by systemic dehydration or an obstruction of the gland. Candida spp. are known colonizers of the oropharynx, salivary gland infection with Candida spp. is extremely rare: only a handful of such cases have been described in the literature As expected, these cases most commonly involve immunocompromised patients A 76-year-old male presented at the emergency department with fever and a red and tender swollen mass in the left parotid region. He was known to have bilateral cystic oncocytic lesions of the parotid glands, as indicated by prior histopathological analysis. Follow-up 3 weeks after discharge showed resolution of the infected parotid cysts (Fig. 2b), and the fluconazol therapy was ceased at day 31

Conclusions

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Discussion