Cases of subcutaneous abscess due to
Candida albicans
(
C. albicans
) infection are rare, even among immunocompromised patients. To our knowledge, there have only been eleven reports of such cases in adults, all of which presented with comorbidities of immunodeficiency, prior antibiotic administration, or skin breakdown following traumatic episodes or iatrogenic procedures.
We report a rare case of a 42-year-old Japanese woman with a subcutaneous abscess due to
C. albicans
infection. The patient was referred to our hospital with a chief complaint of gradually worsening lower left-sided chest pain. Nine months before admission, she underwent laparoscopic cholecystectomy (Lap-C) for acute cholecystitis at another hospital. She developed fever and was treated with cefotiam for three days followed by cefoperazone/sulbactam for four days.
One week after Lap-C, she began to feel pain in the lower left side of her chest. The chest pain worsened gradually and the fever persisted until two months before admission.
On admission, enhanced chest computed tomography revealed a left chest subcutaneous abscess located between the seventh and ninth rib. She underwent surgical percutaneous drainage, and the abscess cavity was cleaned. The pus culture revealed
C.
albicans
, but the blood cultures were negative. We administered intravenous micafungin (150 mg daily) for 10 days, followed by oral fluconazole (600 mg daily). She experienced telogen effluvium during the period of fluconazole treatment but recovered after the cessation of fluconazole.
We also present a short review of the literature relating to subcutaneous candidal abscesses in patients over 15 years old.
With the aging of the population, physicians need to pay more attention to assessing the presence or absence of pelvic fractures and urinary retention associated with urethral injury due to such fractures in the elderly when falling from bicycles.
It is important to suspect intracranial hypotension based on distinctly frequent orthostatic headaches and diffuse dural hyperplasia. Lumbar puncture is a procedure prone to complications, especially in patients with already existing intracranial hypotension.
Background
The coronavirus disease 2019 (COVID-19) outbreak has caused a global pandemic. Critically ill patients with COVID-19 can develop acute respiratory distress syndrome (ARDS) and thrombosis. Angiotensin-converting enzyme 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 to gain entry in cells. This receptor is widely expressed in some hematopoietic cells, including monocytes and macrophages. Infection of these cells results in secretion of interleukin (IL)-6 and other inflammatory cytokines. IL-6 and other inflammatory cytokines can cause ARDS and thrombosis. Elevated IL-6 levels are expected to cause more severe cytokine release syndrome. In this study we investigated the association of the predictive risk scores with the IL-6 level, duration of oxygen therapy (DOT), and D-dimer level.
Methods
We enrolled 20 consecutive patients diagnosed with COVID-19 from April 3, 2020, to April 30, 2020, and determined the predictive risk scores of CALL points (Dong J et al. CID 2020) and COVID-GRAM (Liang W et al. JAMA Int. Med2020) on admission. We statically analyzed the regressions between these two scores and the values of IL-6 and D-dimer and DOT.
Results
The regression lines between CALL points and the values of IL-6, D-dimer, DOT were Y=-2.09 + 0.618X (r=0.821), Y=-0.783 + 0.213X (r=0.510), and Y=-5.32 + 1.26X (r=0.744), respectively. The regression lines between COVID-GRAM and the values of IL-6, D-dimer, and DOT were Y=-0.820 + 0.0344X (r=0.935), Y=-2.70 + 0.0205X (r=0.774), and Y=-1.92 + 0.0491X (r=0.765), respectively. These correlation coefficients were statistically significant. The correlation coefficients of CALL points were in the descending order of IL-6, DOT, and D-dimer. The correlation coefficients of COVID-GRAM were in the descending order of IL-6, D-dimer, and DOT. The coefficient between COVID-GRAM and IL-6 was the highest.
Conclusion
These predictive risk scores of CALL points and COVID-GRAM can be surrogate markers for the IL-6 level in patients with COVID-19. Further research is required to understand the prediction of severity in patients with COVID-19.
Disclosures
All Authors: No reported disclosures
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