Congenital candidiasis: a rare and unpredictable disease

We present a full-term female infant with congenital candidiasis characterized by extensive vesicular and pustular skin lesions associated with pneumonia and severe respiratory distress that appeared during the first hours after birth. The patient was born by cesarean section with no history of rupture of membranes. The mother had a vaginal discharge 3 weeks before delivery. The diagnosis was made by culture of pustular fluid, which grew Candida albicans. Systemic cultures were negative. The infant required a very brief course of conventional mechanical ventilation in spite of impressive and extensive lung infiltrates on the chest radiograph. She made a very quick clinical recovery although it is remarkable that antifungal treatment with amphotericin B was begun very late in her clinical course at the time when she was showing obvious signs of major improvement. Current management guidelines strongly recommend specific therapy for infants with invasive congenital candidiasis or with burn-like extensive dermatitis even without lung involvement. We are not suggesting any change in these recommendations; however, at least in our patient, when amphotericin B was started, she was clearly recovering; it seems possible that her disease although extensive might have experienced an unusual spontaneous regression. This case can provide further insights into this unusual neonatal infection.