Hepatic Candidiasis in an Immunocompetent Woman

Abstract

Pylephlebitis, or portal vein thrombus infection, is a rare condition that is often missed owing to the nonspecific nature of its signs and symptoms and an underappreciation of the clinical entity. Causative microbes are typically bacteria, although cases of candidal pylephlebitis have been described. Given the invasive technique required to culture the portal vein, antimicrobial selection typically relies on the assumption that the microbes isolated in blood culture are the same as those infecting the portal vein thrombus. We present a case of pylephlebitis in an immunocompetent patient with viridans streptococci and Bacteroides fragilis bacteremia subsequently found to have associated hepatic Candida abscesses. Our case highlights the need to proceed with caution when narrowing antimicrobial therapy for patients with pylephlebitis based on blood culture data alone. It also represents a rare exception to the teaching that hepatic Candida abscesses are only seen in individuals who are profoundly immunocompromised.

Hepatic Candidiasis in an Immunocompetent Patient: A Diagnostic Challenge

“…Gottlieb et al reported an immunocompetent woman who developed Candidal hepatic abscesses as a result of pylephlebitis. However, the causative species was Candida dubliniensis in this case [ 9 ]. Menachery et al and Hasan et al both reported a solitary C. albicans liver abscess in their patients [ 10 , 11 ].…”

“…A contrast-enhanced CT scan is the most sensitive investigation, typically depicting multiple, round, hypoattenuating lesions with a central enhancement. A percutaneous liver biopsy can help the definitive diagnosis of Candida in almost three-quarters of the patients if performed [ 9 ]. A diagnostic laparoscopy revealing white lesions on the liver surface can also aid in diagnosis [ 14 ].…”