Candida albicans and Staphylococcus lugdunensis superinfection of liver cysts in a patient with autosomal dominant polyc
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CASE REPORT
Candida albicans and Staphylococcus lugdunensis superinfection of liver cysts in a patient with autosomal dominant polycystic kidney disease under prednisolone treatment Takashi Iijima1 · Tatsuya Suwabe1 · Keita Inui1 · Hiroki Mizuno1 · Rikako Hiramatsu1 · Masayuki Yamanouchi1 · Naoki Sawa1 · Kenmei Takaichi1 · Yoshifumi Ubara1 Received: 19 December 2019 / Accepted: 9 May 2020 © Japanese Society of Nephrology 2020
Abstract We report a case of superinfection of liver cysts caused by Candida albicans and Staphylococcus lugdunensis in a patient with autosomal dominant polycystic kidney disease. A 69-year-old man with chief complaints of headache and blurred vision was admitted to the former institution for the evaluation of suspected temporal arteritis. He was prescribed oral prednisolone (55 mg/day) as a preemptive treatment; however, he became febrile and presented with bilateral flank pain during prednisolone tapering. Blood culture revealed fungemia as a result of Candida famata infection; thus, micafungin treatment was started. Thereafter, recrudescence of the C-reactive protein level ensued. Then a cyst infection as visualized on magnetic resonance imaging led to cyst aspiration sclerotherapy. Cyst aspirate culture revealed the presence of C. albicans in one of the cysts and S. lugdunensis in two of the cysts. The patient was clinically stabilized with an additional 3 weeks of antibiotic and antifungal drug administration. Keywords Autosomal dominant polycystic kidney disease · Cyst infection · Candida albicans · Candida famata · Staphylococcus lugdunensis · Double infection
Introduction * Yoshifumi Ubara [email protected] Tatsuya Suwabe [email protected] Keita Inui [email protected] Hiroki Mizuno [email protected] Rikako Hiramatsu [email protected] Masayuki Yamanouchi [email protected] Naoki Sawa [email protected] Kenmei Takaichi [email protected] 1
Department of Nephrology, Nephrology Center, Toranomon Hospital Kajigaya, Takatsu‑ku Kajigaya 1‑3‑1, Kawasaki City, Kanagawa 213‑8587, Japan
Patients with autosomal dominant polycystic kidney disease (ADPKD) are susceptible to hepatic and renal cyst infections. The incidence of this complication is reported to be 0.01 episode per patient per year [1]. A significant proportion of these patients require invasive treatment modalities, such as percutaneous cyst drainage or partial resection of the liver or kidney. In a multicenter retrospective study, Lantinga et al. reported that 32 out of 77 cyst-infected patients required invasive treatment [2]. Superinfections by Candida with bacterial infections are reported infrequently, and most of them seem to be related to broad-spectrum antibiotic use [3, 4]. Besides microbial substitution, the immunocompromised status of the host such as high-dose glucocorticoid use, older age, and hemodialysis increases the risk of an atypical pathogen infection. Herein, we report a case of a superinfection caused by rare pathogens in an unusual order, that is, Candida famata fu
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