Candida Retinitis in a Liver Transplantation Recipient

Abstract

Introduction: Ocular candidiasis is one of the major complications of disseminated candidiasis in liver transplantation (LT) recipients. In this case report, it is aimed to present a patient developing candida retinitis in LT recipient in the first month after LT and successfully recovered with liposomal amphotericin B therapy. Case presentation: A 52-year-old male patient had been undergone right lobe LT from a living donor. He had diabetes mellitus and underwent serial erythrocyte and thrombocyte transfusions, the score of models for end-stage liver disease (MELD) was 23. On the 14 th day, biliary leakage and infected bilioma determined in multislice abdominal tomography. On the 25 th day, sepsis symptoms such as fever, tachycardia and hypotension developed. Leukocytosis, elevated C-reactive protein (CRP) and procalcitonin were also present. It was started empirically imipenem/cilastatin, teicoplanin, and fluconazole intravenous therapy. In the three blood cultures taken from fever presence, Enterobacter spp. Enterococcus faecium and Candida albicans (caspofungin-sensitive, fluconazole-resistant, MIK level > 256 µg/ ml) respectively were identified. According to the antimicrobial susceptibility test, fluconazole was discontinued and anidulafungin treatment was initiated. On the third day of anidulafungin treatment, the patient having the complaints of headache, decrease in visual acuity. Ophthalmology consultation was requested, as a result of ocular examination candida retinitis was diagnosed in the right eye. There were two focal yellow retinal lesions thought to be candidal plaques in retina and macula. Because of not successful to reach higher concentrations in cerebral tissues, the anidulafungin treatment was altered to liposomal amphotericin B. The antifungal treatment was also administrated intravitreal. The blood culture was sterile at the day of fourteen. All of the complaints downgraded, and the retinitis symptoms recovered at the end of 28-day treatment. So, antifungal treatment was discontinued because of normal ocular examination. Conclusions: LT recipients have a high risk of disseminated candidiasis, the ophthalmological examination should never be neglected because candida retinitis is a common variant of disseminated candidiasis.