Diverticulitis complicated by candidal pylephlebitis.

Area of Science:

• Medical Mycology
• Infectious Diseases
• Gastroenterology

Background:

• Polymicrobial bacteremia can present with severe symptoms and resistance to standard antibiotic treatments.
• Diverticular abscesses and pylephlebitis are serious intra-abdominal conditions often requiring surgical or interventional management.
• Fungal co-infections can complicate bacterial sepsis, leading to increased morbidity and mortality.

Observation:

• A 58-year-old female patient presented with fever, diarrhea, and polymicrobial bacteremia.
• The patient's condition deteriorated progressively despite appropriate antibiotic therapy.
• Autopsy revealed a diverticular abscess and pylephlebitis.

Findings:

• Microscopic examination of the abscess and pylephlebitis specimens showed fungal hyphae.
• The morphological characteristics of the hyphae were consistent with Candida species.
• This suggests a fungal infection, likely Candida, co-existed with and potentially exacerbated the bacterial infection.

Implications:

• This case highlights the importance of considering fungal co-infections in patients with severe, refractory polymicrobial bacteremia, especially those with intra-abdominal pathology.
• Early identification and treatment of fungal infections, such as those caused by Candida, are crucial for improving patient outcomes in complex sepsis cases.
• The findings underscore the need for thorough diagnostic evaluation, including fungal markers, in critically ill patients with intra-abdominal sepsis and treatment failure.