Mixed Fungal Pneumonia and Candidemia in Immunocompromised Patient -Case Presentation and Literature Review

Dr. Hythum Salah H. Mohamed –NGHA-KAMC-Riyadh-May 2015

Case Description

73 years old female – D.O.A 2nd April 2015 . Admitted with fever and fatigability for 3 days . PMH of HTN , old CVA ,DVT ,Osteoporosis and she is recently

diagnosed with Multiple Myeloma . She is on chemotherapy . Examination -- vital signs on admission was normal apart from

tachypnea . abdominal tenderness but soft abdomen .

Pt received Tazocin + i.v Fluid and septic workup was done ( Sepsis ?) .

After 2 days of ER stay Pt deteriorated and developed shortness of breath and being hypoxic with decrease level of consciousness GCS 13/15 with decrease air entry in the chest mainly in the right side .

Pt transferred to the ICU . She required Mechanical Ventilation and later inotropes and she

developed acute renal failure and liver injury (Failure ) .

Blood and Respiratory cultures came positive after day 12 -4-2015 .

Despite treatment unfortunately she died on day 20 -4-2015 .

Respiratory C/S (BAL) showed Aspergillus Flavus in multiple cultures in days 11, 12,15 and 21 -4 -2015 .

Respiratory C/S (BAL) showed Candida Tropicalis in multiple cultures in days 11, 12 ,15 and 21-4 -2015 .

Blood culture showed Candida Tropicalis , pan sensitive in 12th -4-2015 .

Aspergillus glactomanan positive in 12th -4-2015 . Others was negative , Influnza , MERS-Cov and AFB . Rectal swab positive for carbapenem resistant klebsiella

pneumoniae .

Antimicrobials Days

Tazocin+Vancomycin+Metrindazole

2-4 - 2015

Ostelmvir +Meropenenm 5 -5-2015

Stop all and start Ceftriaxone 7-4-2015

Voriconazole 10-4-2015

Voric+Meropenem+Vancomycin 13-4-2015

Added Anidulafungin 14-4-2015

Anidulaf+Voric+Merope+Vancomycin

15-4-2015

DC Andiulf and Voric and Vancomycin

19-4-2015

Start Amphotrc Lipid complex+Merop+

Antimicrobials

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