[Recurrent Candida sepsis with prolonged respiratory failure and severe liver dysfunction].

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Hepatology

Background:

• Systemic mycoses, particularly candidemia, are increasing in intensive care units (ICUs).
• Risk factors include broad-spectrum antibiotic use and immunocompromised states, often seen post-transplantation or with severe illness.
• Candida albicans is a common pathogen, though blood cultures are often negative unless fungemia is massive.

Observation:

• A 50-year-old patient experienced recurrent Candida septicemia following esophageal rupture, leading to mediastinitis, acute respiratory distress syndrome, septic shock, and acute renal failure.
• The patient required prolonged mechanical ventilation, continuous renal replacement therapy, and broad antibiotic treatment.
• Subsequent complications included severe intrahepatic cholestasis and recurrent systemic infections with various pathogens, including Candida species.

Findings:

• Early cultures confirmed Candida albicans, with later detection of Pseudomonas, Staphylococci, and Enterococci.
• Artificial liver support (MARS-system) improved high bilirubin levels and the patient's clinical condition.
• Recurrent Candida septicemia episodes correlated with rising bilirubin levels and cholestatic hepatosis, consistently improving with antimycotic therapy (voriconazole, caspofungin, fluconazole).

Implications:

• This case illustrates a rare instance of recurrent Candida septicemia with prolonged respiratory failure and severe cholestatic hepatosis.
• Effective management involved a combination of evidence-based intensive care, artificial organ support, and targeted antimycotic therapy.
• The patient exhibited progressive immunodeficiency, underscoring the complexity of managing systemic Candida infections in critically ill, immunocompromised patients.