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Control of a Candida glabrata prosthetic endovascular infection with posaconazole

G M Anstead1, M Martinez, J R Graybill

  • 1Medical Service, Department of Veterans Affairs Medical Center, South Texas Veterans Heatlh Care System, San Antonio, USA.

Medical Mycology
|May 17, 2006
PubMed

Insights

Posaconazole effectively managed Candida glabrata fungemia in a liver cirrhosis patient post-TIPS, demonstrating its potential for prosthetic endovascular infections.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Transjugular intrahepatic portosystemic shunt (TIPS) placement is a procedure used in patients with liver cirrhosis.
  • Candida glabrata fungemia is a serious bloodstream infection that can occur in immunocompromised patients.
  • Prosthetic endovascular infections pose significant treatment challenges.

Observation:

  • A patient with liver cirrhosis developed Candida glabrata fungemia after TIPS placement.
  • Initial fluconazole treatment failed when the patient became neutropenic, with persistent fungemia and thrombus formation.
  • Posaconazole treatment led to clinical improvement and partial resolution of the thrombus.

Findings:

  • Posaconazole controlled Candida glabrata fungemia for approximately 3 months in a complex patient case.
  • Resolution of inferior vena cava thrombus was observed on CT scan during posaconazole therapy.
  • Despite initial control, infection recurred when the patient became noncompliant with posaconazole due to other health issues.

Implications:

  • Posaconazole may be a valuable therapeutic option for prosthetic endovascular infections caused by Candida glabrata.
  • This case highlights the challenges in managing fungal infections in patients with advanced liver disease and indwelling devices.
  • Maintaining treatment compliance is crucial for successful outcomes in managing chronic or recurrent fungal infections.

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