A Case of Delayed Onset Chest Wall Abscess after Candidemia

Hana Yoo; Chang Su Chung; Sung Woong Jung; In Ho Moh; WonKeun Song; Jacob Lee

doi:10.3947/ic.2012.44.3.188

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Yoo, Chung, Jung, Moh, Song, and Lee: A Case of Delayed Onset Chest Wall Abscess after Candidemia

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(3): 188-192.

Published online: 30 June 2012

DOI: https://doi.org/10.3947/ic.2012.44.3.188

A Case of Delayed Onset Chest Wall Abscess after Candidemia

Hana Yoo¹, Chang Su Chung¹, Sung Woong Jung¹, In Ho Moh¹, WonKeun Song², Jacob Lee¹

¹Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea.

²Department of Laboratory Medicine, College of Medicine, Hallym University, Seoul, Korea.

Correspondence to Jacob Lee, M.D. Division of Infectious Disease, Departments of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, 948-1, Daerim-1 dong, Yeongdeungpogu, Seoul 150-950, Korea. Tel: +82-2-829-5441, Fax: +82-2-829-4469, litjacob@chol.com

Received 13 April 2011 Revised 30 August 2011 Accepted 28 September 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, the incidence of candida infection has increased. Candida species often show hematogenous spread to the kidney, brain, heart, and eyes. And delayed onset of hematogenous spread is relatively rare. A 53-year-old female patient was admitted with left anterior chest pain with swelling and mild fever. She had been treated successfully with fluconazole for candidemia caused by C. albicans eight month ago. On admission chest CT scan revealed multiple subcutaneous abscesses involving the anterior chest. Percutaneous drainage of the abscess was performed. C. albicans was isolated from drained pus. Treatment with fluconazole did not to improve the abscess; therefore, micafungin and voriconazole were administered as a replacement. The patient recovered after 10-week administration.

Keywords: Candidemia, Fluconazole, Micafungin, Voriconazole

Figures and Tables

Figure 1

Initial contrast-enhanced CT scan shows multiple subcutaneous abscesses involving the anterior chest (An abscess measuring 8.0×6.4×5.4 cm just below the left breast, an abscess measuring 3.0×1.7 cm adjacent to the right xiphoid process, and an abscess measuring 3.6×2.5 cm attached to the sternum).

Figure 2

After 40 days of fluconazole 400 mg/d treatment, contrast-enhanced CT scan shows a more enlarged abscess at the left anterior chest wall (9.0×5.8×5.7 cm) and smaller abscesses at the right and sternal area (1.5×1.5 cm and 2.6×2.2 cm).

Figure 3

19 days of micafungin 100mg/d treatment followed by 28 days of voriconazole 400 mg/d treatment, contrast-enhanced CT scan shows improved abscess after micafungin and voriconazole therapy.

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