An Atypical Source of Persistent Fungemia in the Intensive Care Unit

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Cardiology

Background:

• Candidemia presents a significant mortality risk (>50%) in critically ill and immunocompromised individuals.
• Common sources include central venous catheters, intra-abdominal collections, and valvular vegetations.
• Standard treatments may involve surgical intervention or anticoagulation.

Observation:

• A 63-year-old female with multiple comorbidities developed Candida species fungemia during ICU admission for diabetic ketoacidosis and gastrointestinal bleeding.
• Initial workup, including imaging and hip aspiration, failed to identify the infection source.
• Fungemia persisted despite catheter removal and antifungal treatment.

Findings:

• A venous thromboembolism was identified as the likely source of persistent fungemia.
• Initiation of anticoagulation therapy, combined with continued antifungals, led to blood culture clearance.
• The patient showed overall clinical improvement.

Implications:

• Septic thrombi should be considered in the differential diagnosis for fungemia in high-risk patients, particularly those with venous thromboembolism.
• This case highlights the importance of a comprehensive diagnostic approach for persistent candidemia.
• Anticoagulation may be a crucial component in managing certain cases of candidemia originating from septic thrombi.