Infect Chemother.  2012 Jun;44(3):188-192. 10.3947/ic.2012.44.3.188.

A Case of Delayed Onset Chest Wall Abscess after Candidemia

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea. litjacob@chol.com
  • 2Department of Laboratory Medicine, College of Medicine, Hallym University, Seoul, Korea.

Abstract

Recently, the incidence of candida infection has increased. Candida species often show hematogenous spread to the kidney, brain, heart, and eyes. And delayed onset of hematogenous spread is relatively rare. A 53-year-old female patient was admitted with left anterior chest pain with swelling and mild fever. She had been treated successfully with fluconazole for candidemia caused by C. albicans eight month ago. On admission chest CT scan revealed multiple subcutaneous abscesses involving the anterior chest. Percutaneous drainage of the abscess was performed. C. albicans was isolated from drained pus. Treatment with fluconazole did not to improve the abscess; therefore, micafungin and voriconazole were administered as a replacement. The patient recovered after 10-week administration.

Keyword

Candidemia; Fluconazole; Micafungin; Voriconazole

MeSH Terms

Abscess
Brain
Candida
Candidemia
Chest Pain
Drainage
Echinocandins
Eye
Female
Fever
Fluconazole
Heart
Humans
Incidence
Kidney
Lipopeptides
Middle Aged
Pyrimidines
Suppuration
Thoracic Wall
Thorax
Triazoles
Echinocandins
Fluconazole
Lipopeptides
Pyrimidines
Triazoles

Figure

  • Figure 1 Initial contrast-enhanced CT scan shows multiple subcutaneous abscesses involving the anterior chest (An abscess measuring 8.0×6.4×5.4 cm just below the left breast, an abscess measuring 3.0×1.7 cm adjacent to the right xiphoid process, and an abscess measuring 3.6×2.5 cm attached to the sternum).

  • Figure 2 After 40 days of fluconazole 400 mg/d treatment, contrast-enhanced CT scan shows a more enlarged abscess at the left anterior chest wall (9.0×5.8×5.7 cm) and smaller abscesses at the right and sternal area (1.5×1.5 cm and 2.6×2.2 cm).

  • Figure 3 19 days of micafungin 100mg/d treatment followed by 28 days of voriconazole 400 mg/d treatment, contrast-enhanced CT scan shows improved abscess after micafungin and voriconazole therapy.


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