Pacemaker-related Candida parapsilosis fungaemia in an immunosuppressed renal transplant recipient

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Cardiology

Background:

• Renal transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.
• Invasive fungal infections, such as candidiasis, pose a significant risk in this population.

Observation:

• A 59-year-old renal transplant recipient presented with sepsis and bilateral pulmonary emboli.
• Infection was caused by Candida parapsilosis, with vegetations identified on pacemaker leads via transesophageal echocardiogram.

Findings:

• Initial treatment with caspofungin was followed by surgical lead replacement, but blood cultures remained positive.
• Switching to liposomal amphotericin B and flucytosine achieved sterile cultures, followed by lifelong fluconazole.
• The patient experienced tacrolimus toxicity due to fluconazole-induced CYP3A inhibition.

Implications:

• This case underscores the challenges in treating invasive Candida infections in transplant patients, particularly those with device involvement.
• Management requires a multidisciplinary approach, including infectious disease, transplant, and cardiology specialists.
• Awareness of drug-drug interactions, such as fluconazole and tacrolimus, is critical for preventing complications and optimizing patient outcomes.