Candida glabrata Isolated From Tubo-Ovarian Abscess Cultures in Two Immunocompetent Patients

In this clinical case report, we present two immunocompetent patients with tubo-ovarian abscesses (TOAs) that were positive for Candida glabrata. TOAs usually develop as a complex and severe complication of pelvic inflammatory disease, primarily have a polymicrobial etiology, and nearly all causative pathogens are bacteria. But, more rarely, fungal species are also isolated^1-3. Both patients presented to our hospital with TOAs that were refractory to the usual management involving antibiotics and drainage, and after the identification of C. glabrata in abscess cultures, they were successfully treated with caspofungin. The first patient, a 34-year-old female, presented from an outside hospital after a TOA diagnosis, for which she was treated with intravenous (IV) antibiotics and the placement of an endoscopic stent between the abscess and the sigmoid colon. The patient was managed with transvaginal drainage and multiple rounds of antibiotics during two hospitalizations. After abscess cultures grew C. glabrata, caspofungin was added to her treatment, and this resulted in clinical improvement. The second patient, a 39-year-old female diagnosed with a TOA after presenting with sepsis, was initially treated with IV antibiotics for four weeks and underwent percutaneous drainage. After minimal improvement, laparoscopic evacuation was performed, and the cultures grew C. glabrata. Caspofungin was added, and follow-up imaging two weeks later showed complete resolution of the TOA. Fungal species may contribute to TOAs, and our experience suggests that adding caspofungin to the usual treatment may be effective, although surgery may additionally be necessary. Even without significant risk factors, treatment with antifungals should be considered for patients not improving with typical management that includes antibiotics and percutaneous drainage.