Neonatal Candida albicans Septic Thrombosis of the Portal Vein followed by Cavernous Transformation of the Vessel

Abstract

We report two premature neonates with Candida albicans septic thrombosis of the portal vein who developed, in very early childhood, the sonographic appearance of cavernous transformation of the vessel and/or clinical signs of extrahepatic portal hypertension. CASE REPORTS Case 1. A 1,980-g male infant, who was the second infant delivered, was born by emergency cesarean section for fetal distress after a 34-week-triplet gestation to a 35-year-old primigravida mother. Except for premature labor, her pregnancy had been otherwise normal, without prolonged rupture of membranes or maternal fever. The infant had respiratory distress immediately after birth and was therefore admitted to the neonatal intensive care unit (NICU), where he was treated for 2 days with nasal continuous positive airway pressure (CPAP) and for 5 days with oxygen therapy. On admission to the NICU, a polyvinyl chloride 5 French catheter was inserted into the umbilical vein, and intravenous ampicillin and netilmicin were started for suspected sepsis. The catheter tip was noted to be in the inferior vena cava. Blood culture obtained on admission gave negative test results, and antibiotics were discontinued after 3 days. On postnatal day 8, he developed apnea and bradycardia, irritability, feeding difficulties, and abdominal distension. The same day, the catheter was removed, the cathetertip, blood from peripheral veins, and urine cultures were taken, and the infant was started on teicoplanin therapy. While the infant continued to be symptomatic, on postnatal day 10, the laboratory report for the positive cultures of the catheter tip indicated a pure growth of Candida albicans and treatment was changed to oral fluconazole. On postnatal day 11, the blood culture performed 3 days earlier was reported to have yielded a heavy (defined as Ն50 CFU/ml) (24) growth of C. albicans (sensitive to fluconazole and amphotericin B). He continued treatment with fluconazole for 6 weeks and on day 11 started a 6-week intravenous amphotericin B treatment. Soon after the positive blood culture result, a disseminated fungal workup including abdominal and cranial ultrasound, echocardiogram, and ophthalmologic evaluation was performed. The echocardiogram, cranial ultrasound, and ophthalmologic evaluation were negative. Abdominal gray-scale ultrasound showed that both right and main portal veins were completely filled with hyperechoic thrombus. The spleen was of normal size, but the liver appeared slightly enlarged without sonographic abnormalities of the hepatic parenchyma or of the biliary structures. A second cranial ultrasound revealed, in the parietal and temporal lobes, multiple, bilateral, round hypoechoic lesions with echogenic rims, which were consistent with intracranial abscesses (18). A peripheral venipuncture blood culture obtained 1 week after initiation of antifungal therapy was still positive for C. albicans. However, it became sterile 11 days after antifungal treatment was started. At 35 days of age, the cranial ultrasound became normal, but the abdominal ...

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

“…One older case study from 1998 was incorporated because of the unique, descriptive information provided, resulting in a total of 72 available publications for data assessment. Following critical appraisal of the resources and selection criteria, 19 were retained (Table ) . All of the publications over the 19 years were case reports or case series.…”

“…Following critical appraisal of the resources and selection criteria, 19 were retained (Table 4). 2,4,6,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] All of the publications over the 19 years were case reports or case series. Excluded articles were either nonspecific to PVT, did not include any specific case scenarios (infants or neonates were not individually identifiable or combined with results of children), failed to meet age criteria or did not specify ages of the subjects or did not specifically discuss the use of ACT.…”

“…Apart from umbilical venous catheterization, numerous other risk factors are associated with PVT in neonates, but the cause‐and‐effect relationship is not firmly established. Prematurity, sepsis, small for gestational age infants with concurrent polycythemia, perinatal asphyxia, thrombophilia, congenital heart disease, prolonged UVC stay (>6 days), and infusion of blood products through the UVC have all been implicated, but the exact risk of PVT is unclear . Genetic prothrombotic mutations and their contribution to PVT and umbilical catheter related thrombosis have also been investigated, but the evidence is also inconclusive.…”

“…The key long‐term outcomes from neonatal PVT that result in morbidity and mortality are liver lobe atrophy, portal hypertension, esophageal varices, portal collaterals, and cavernoma . The incidence of these findings is dependent totally on the duration of follow‐up.…”

“…The key long-term outcomes from neonatal PVT that result in morbidity and mortality are liver lobe atrophy, portal hypertension, 2,12,24,25 esophageal varices, 19,24,25 portal collaterals, 19,23 and cavernoma. 19,24,27 The incidence of these findings is dependent totally range, 1 month-15 years 2 months) with portal vein obstruction. 44 In our study, only three children were followed for greater than five years.…”