CandidaArteritis in Patients Who Have Not Received Organ Transplants: Case Report and Review of the Literature

Abstract

Fungal arteritis is a rare entity, associated with significant morbidity and mortality, that typically involves graft arteries in solid organ transplant recipients. Here, we report the first case of Candida carotid arteritis and review 22 other cases of Candida arteritis reported since 1966 in patients who have not received transplants. Most patients had serious underlying conditions. All cases were anatomically characterized by pseudoaneurysm formation. Patients presented with fever (n=7), local pain (n=13), and an expanding pulsatile mass (n=4), with subsequent rupture and hemorrhage (n=7). Evidence of Candida colonization or infection was present in 15 patients before arteritis occurred. Treatment typically included a combined surgical and antifungal approach. The outcome was favorable in 11 patients, but follow-up was limited. A high index of suspicion, early diagnosis, and prompt antifungal and surgical treatment seem crucial to efforts to avoid life-threatening arterial rupture and hemorrhage.

Evidence That Graft‐Site Candidiasis after Kidney Transplantation Is Acquired during Organ Recovery: A Multicenter Study in France

“…Fungal aneurysms or arteritis are mostly attributable to Candida or Aspergillus species, which have been shown to invade vascular endothelium [20][21][22][23]. Twenty-one cases of arteritis due to Candida species after renal transplantation have been reported and have often been associated with a poor outcome (death attributable to massive bleeding [9,10] or nephrectomy [5,6,[8][9][10][24][25][26][27]), and only 3 patients have kept their grafts [5,26,28].…”

Candida albicans–associated necrotizing vasculitis producing life-threatening gastrointestinal hemorrhage

“…The typical means whereby candidal infection produces vascular pathology is either through direct vascular wall invasion by fungal organisms producing mycotic aneurysm or simple occlusion of the vessel lumen with fungal organisms as in thrombophlebitis/septic embolus [5,6]. Most patients have documented candidal infection before the development of candidal arteritis, and typically, there is a predisposing contributory condition such as advanced neoplasia, diabetes mellitus, intravenous drug abuse, longterm steroid treatment, organ engraftment, or end-stage renal disease.…”

Presentation and Management of Candida‐Associated Vasculitis With Gastrointestinal Involvement in a Pediatric Patient

“…Infections account for approximately 80% of all early deaths in patients undergoing remission induction chemotherapy for acute lymphoblastic leukemia (ALL) in the pediatric population with candidal species accounting for 10% to 15% of these infections (1). A rarely described complication of candidal infection is vasculitis (2,3), with resulting pseudoaneurysms through vascular wall invasion (4). Gastrointestinal (GI) hemorrhage in this setting is difficult to manage because of the diffuse involvement of the GI tract.…”