Invasive candidiasis presenting multiple pulmonary cavitary lesions on chest computed tomography
© Yasuda et al.; licensee BioMed Central. 2015
Received: 6 January 2015
Accepted: 2 March 2015
Published: 20 March 2015
We herein report a case of invasive candidiasis presenting rare findings on chest computed tomography (CT). The chest CT scan showed multiple small cavitary lesions and nodules with surrounding ground-glass opacity, and also bilateral pleural effusion. Although this CT finding is thought as specific for pulmonary aspergillosis, two sets of blood culture specimens were drawn which yielded Candida albicans in our case. Antifungal therapy was started and the chest CT findings showed a remarkable improvement. To our knowledge, this is the first case report describing multiple pulmonary cavitary lesions in invasive candidiasis.
KeywordsCanididemia Computed tomography Invasive candidiasis Pulmonary cavity
It has been reported that invasive candidiasis is rare but associated with considerable mortality in immunocompromised or critically ill patients. The most common chest computed tomography (CT) findings of invasive candidiasis have been reported as multiple bilateral nodules often associated with air-space consolidation . Here, we present a rare case of invasive candidiasis presenting multiple pulmonary cavitary lesions on chest CT. To our knowledge, this is the first case report of invasive candidiasis with this finding in English literatures.
Candida spp. exist as normal flora of the human skin, oropharynx, lower gastrointestinal tract, and genitourinary system. Candida spp. are now one of the most common causes of nosocomial blood stream infections worldwide . Invasive candidiasis is a fungal infection that can occur when Candida spp. enter the bloodstream. Once the fungus is in the bloodstream, it can spread to other parts of the body and cause infection. There are risk factors for invasive candidiasis, such as central venous catheter, surgical procedure, acute renal failure, disseminated intravascular coagulopathy, parenteral nutrition and the use of broad-spectrum antibiotics . In our case, parenteral nutrition with CV catheter was thought to be the risk factor for invasive candidiasis. Moreover, small bowel obstruction was also thought to be the risk factor because the protective mechanisms of intestinal mucosa were thought to be broken.
The few available studies on this topic indicate that pulmonary manifestations of invasive candidiasis are seen in no more than 0.2 to 8.0% of at-risk ICU patients and cancer patients . As with other opportunistic mycoses, sputum cultures are unreliable for diagnosis, because the organism frequently colonizes in the upper airways, and a definitive diagnosis requires culture of Candida from blood, normally sterile organ or body cavity [3,4]. We could diagnose our case as invasive candidiasis by the positive blood culture and chest CT findings. The most common chest CT findings were reported as multiple bilateral nodules often associated with air-space consolidation, however these findings are nonspecific and the differentiation from other fungal infections (especially aspergillosis) is difficult. In pulmonary fungal infections cavitation has been considered to represent concomitant bacterial infection or hemorrhagic lung infarcts, and the surrounding ground-glass or air-space opacity has been considered to represent a mixture of edema and hemorrhage . The multiple cavitary lesions seen in our patient were thought to represent septic pulmonary infarcts due to blood-stream infection of Candida albicans, and this CT finding is rare in invasive candidiasis. It was reported that cavitary lesions were less common in invasive candidiasis (4%) than in aspergillosis (16%) , and, to our knowledge, this is the first case report describing multiple pulmonary cavitary lesions in invasive candidiasis.
In conclusion, multiple pulmonary cavitary lesions are rare CT manifestations of invasive candidiasis. This CT finding is thought as specific for pulmonary aspergillosis, however, we should also consider this finding in invasive candidiasis occurring in patients who have risk factors. We believe that our case will be helpful to the understanding and recognition of the spectrum of this rare condition.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Franquet T, Müller NL, Lee KS, Oikonomou A, Flint JD. Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings. Radiology. 2005;236:332–7.View ArticlePubMedGoogle Scholar
- Evans SE. Coping with Candida infections. Proc Am Thorac Soc. 2010;7:197–203.View ArticlePubMedGoogle Scholar
- De Marie S. New developments in the diagnosis and management of invasive fungal infections. Haematologica. 2000;85:88–93.PubMedGoogle Scholar
- Bajwa SJ, Kulshrestha A. Fungal infections in intensive care unit: challenges in diagnosis and management. Ann Med Health Sci Res. 2013;3(2):238–44.View ArticlePubMed CentralPubMedGoogle Scholar
- Althoff Souza C, Müller NL, Marchiori E, Escuissato DL, Franquet T. Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings. J Thorac Imaging. 2006;21:184–9.View ArticlePubMedGoogle Scholar
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