Lethal soft-tissue necrosis early after organ transplantation: a case report

Necrotizing soft tissue infection (NSTI) is a rapidly spreading infection which affects subcutaneous tissue, extending to a muscular level. Early and aggressive surgical exploration is frequently necessary, especially in patients with significant comorbidities or advanced age. NSTIs are commonly caused by Streptococcus pyogenes or methicillin resistant Staphylococcus aureus, though monomicrobial infections with Candida species have been reported.

A 64-year-old developed an NSTI of the upper left leg following bilateral lung transplantation. The patient presented with atypical clinical and radiographical symptoms, leading to initial management with antimicrobial therapy. Cultures taken preoperatively and intraoperatively were positive for Candida albicans without the presence of other microorganisms. Surgical exploration revealed extensive necrosis of the upper left leg and groin, resulting in deep sepsis which ultimately led to the patient's death.

NSTI should be monitored with extra vigilance in immunocompromised or otherwise at risk patients, especially when exhibiting atypical symptoms or disease course. Extensive surgical exploration remains the cornerstone of adequate treatment.

NSTIs caused by monomicrobial infections with C. albicans are rare and typically progress rapidly. We report a case of monomicrobial NSTI in an immunocompromised patient following bilateral lung transplantation characterized by atypical presentation and course, with C. albicans as the main pathogen.