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Torulopsis glabrata pelvic abscess and fungemia
H C Wiesenfeld1, S R Berg, R L Sweet
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pennsylvania.
Background:
Serious infections caused by Torulopsis glabrata, once rarely encountered, have become common over the last 3 decades. The most frequent manifestations of serious fungal infections include septicemia, endocarditis, hepatosplenic infections, and meningitis. We report a case of fungemia and pelvic abscess caused by T glabrata following gynecologic surgery.
Case:
A 43-year-old woman developed fever, abdominal pain, and abdominal distention following a total abdominal hysterectomy and right salpingo-oophorectomy. Empirical treatment with broad-spectrum antimicrobial agents was not successful. Three sets of blood cultures were positive for T glabrata, and radiologic investigations revealed pelvic and lesser sac fluid collections. Cultures of the pelvic abscess grew T glabrata. Treatment was changed to amphotericin B, with complete clinical recovery.
Conclusion:
Serious T glabrata infections are rare following gynecologic surgery, especially in immunocompetent patients. Given the morbidity and mortality associated with these infections, aggressive treatment with amphotericin B and drainage of abscesses is warranted.
Insights
Serious Torulopsis glabrata infections are rare after gynecologic surgery. This case highlights the need for aggressive treatment with amphotericin B and abscess drainage for successful outcomes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Surgical Infections
Background:
- Serious fungal infections caused by Torulopsis glabrata (T glabrata) have increased over the past 30 years.
- Common serious manifestations include septicemia, endocarditis, hepatosplenic infections, and meningitis.
- T glabrata infections are uncommon following gynecologic surgery, particularly in immunocompetent individuals.
Observation:
- A 43-year-old woman presented with fever, abdominal pain, and distention post-hysterectomy and oophorectomy.
- Initial broad-spectrum antimicrobial therapy was ineffective.
- Blood cultures and pelvic abscess aspirate confirmed T glabrata fungemia and infection.
Findings:
- T glabrata fungemia and pelvic abscess occurred after gynecologic surgery.
- Radiologic imaging identified pelvic and lesser sac fluid collections.
- Treatment with amphotericin B resulted in complete clinical recovery.
Implications:
- This case underscores the rarity but potential severity of T glabrata infections post-gynecologic procedures.
- Aggressive management involving amphotericin B and surgical drainage is crucial.
- Early recognition and prompt treatment are vital to reduce morbidity and mortality.