Track: Case Reports

Topic: Infectious Diseases

Abstract:

Fungal septicemia is an uncommon condition that mainly affects immunocompromised and hyperglycemic patients, with Candida species being the most common cause. Here, we report the case of a 15-year-old female diagnosed with necrotizing fasciitis due to Candida kruseii infection. The patient was immunocompromised due to previous chemotherapy for recurrent pre B-ALL and hypoglycemia. Initially, the patient was presented with hypotension and signs of sepsis, and further evaluation revealed clinical manifestations of cellulitis on the left lower extremity. Given concern for necrotizing fasciitis, a skin biopsy was performed, which showed marked disseminated intravascular fungal elements, partially necrotic epidermis, and dermal edema. Fungal infection was confirmed with PAS and GMS stains and molecular testing, leading to the diagnosis of candidal septicemia. Disseminated candidiasis typically does not present with cutaneous lesions, and its aggressive nature and diagnostic challenges, with positive cultures found in only 25% of cases, make this infection life-threatening. It has been shown the early diagnosis of disseminated candidiasis can be done by skin biopsy which enables rapid initiation of treatment and reduces mortality risk. This case underscores the importance of skin biopsy in immunocompromised patients with maculopapular or cellulitis-like rashes to establish a diagnosis promptly and facilitate early treatment.

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Lindsey Collins, MD