BILIARY CANDIDIASIS CAUSED BY CANDIDA GLABRATA IN PATIENT WITH PANCREATIC MALIGNANCY S. Rashid; N. Hafiz; V. Nguyen Department of Internal Medicine, LSU Health Sciences Center – Shreveport Introduction: Acute cholangitis presents with fever, right upper quadrant pain and jaundice. Although many causes are due to bacterial translocation in biliary tree, fungal infections are also seen. Risk factors include immunocompromised state, malignancy, diabetes, and chemotherapy. We present here a case of a patient with biliary candidiasis from Candida glabrata . Case: A 68-year old man with history of type 2 diabetes, Hepatitis C, and tobacco use admitted for jaundice, intense pruritus, dark urine and weight loss of 30lbs over 1 month. Labs were significant for T bili 32.4, AST 61, ALT 62, ALP 201, lipase 3,300. CT showed a 2.5 x 3.6 cm pancreatic head mass, enlarged gallbladder and CBD diameter 1.1cm. ERCP showed distal CBD stricture 3-4cm in length with bile duct obstruction. Plastic stent placed, T bili trended down. Three days later, repeat ERCP performed with metal stent placement. EUS with FNA of pancreatic head confirmed malignancy. Patient was not surgical candidate. After second ERCP, T bili and LFT’s worsened, patient became oliguric with worsening creatinine function. Urinalysis confirmed large bilirubin crystals and blood. The patient became hypoxic, hypotensive, anuric and altered. He was started on vasopressors and CRRT, with improvement in creatinine. The patient went into acute liver failure with transaminitis and elevated INR. RUQ US findings were suggestive of a malpositioned stent. IR placed percutaneous cholecystostomy tube which drained thick dark bile. Despite aggressive management for septic shock, the patient’s condition deteriorated and he expired. Gallbladder aspirate grew Candida glabrata . Discussion: Systemic and localized candida infections are common in patients with certain predisposing factors such as neutropenia, malignancy, advanced diabetes mellitus, and immunocompromised status. Biliary
in a patient with bladder cancer. O. intermedium is susceptible to imipenem, ciprofloxacin, and trimethoprim- sulfamethoxazole, but resistant to penicillins and cephalosporins. Conclusion: There are few documented cases of O. intermedium . This is one of the first with bacteremia in the absence of malignancy or immunosuppressant medication. Many were likely classified as O. anthropi previously. Hospital Medicine physicians should recognize Ochrobactrum as an opportunistic pathogen which can cause life- threatening infection particularly in immunocompromised hosts.
candidiasis is very rare even in patients with systemic candidiasis. Patients typically present as acute cholangitis. According to Domargk et al, 29% of the patients present as biliary obstruction similar to our case presentation. Labs generally are remarkable for conjugated hyperbilirubinemia. Diagnosis is made via obtaining culture and sensitivity of biliary fluid sampled through ERCP, cholecystectomy and/or percutaneous cholecystostomy. Management includes source control and antifungal therapy. Unfortunately in our patient, diagnosis was confirmed after he expired due to worsening septic shock.
22 J LA MED SOC | VOL 171 | NO. 1
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