An Unusual Case of Candida albicans Empyema in Patient With Gastric Cancer and Colon Metastasis

Trivedi, Bhavi; Vahora, Ilma; Guzmán, Jesús Grávalos; Desai, Rohan; Cartagena, Juan; Chang, Aymara Y

doi:10.7759/cureus.34023

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…empyema increases in gastrointestinal malignancy such as esophageal cancer, esophageal fistula, and perforation. 6 – 8 We found cancer in 23.1% of patients, not only gastrointestinal esophageal malignancy but also breast cancer. Candida spp.…”

Section: Discussionmentioning

confidence: 77%

Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan

Iqbal,

Ali,

Zahid

et al. 2023

Therapeutic Advances in Infection

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Background and objective: Fungal empyema is a rare entity which is associated with high mortality. It is mostly seen in immune-compromised hosts. However, there is limited data available on fungal empyema from developing countries regarding risk factors, treatment, and outcome. This study was conducted to determine the risk factors, clinical features, treatment, and outcome of fungal empyema. Methods: A retrospective observational study was performed on proven fungal empyema cases, admitted at Aga Khan University Hospital, Karachi, Pakistan during January 2018 to May 2021. We excluded all those patients with polymicrobial bacterial and fungal empyema or with negative pleural fluid cultures. A preformed questionnaire was filled out for each case. Results: A total of 26 patients were diagnosed with fungal empyema with a mean age of 43.6 ± 20.3 years. Of these, 16 (61.5%) patients were male. Diabetes mellitus was the most frequent comorbidity ( n = 11, 42.3%), followed by hypertension ( n = 9, 34.6%), malignancy ( n = 6, 23.1%), and asthma ( n = 1, 3.8%). Ten (38.5%) patients had multiple comorbidities. Candida spp. was isolated in 21 (80.8%) patients and Aspergillus spp. in 7 (26.9%) patients. Fusarium spp. was isolated from one (3.9%) patient. Video-assisted thoracoscopy surgery was done in 14 (53.8%) patients and 12 (46.1%) patients were managed with tube thoracostomy. Twenty-one (80.8%) patients received antifungal agents. Overall, in-hospital mortality was 38.5% ( n = 10) and all patients developed respiratory failure. Clinical improvement was seen in 16 (61.5%) patients. Conclusion: Our data suggest that fungal empyema has a poor outcome as almost one-third of our patients died. Early diagnosis and intervention can improve outcome.

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Section: Discussionmentioning

confidence: 77%

Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan

Iqbal,

Ali,

Zahid

et al. 2023

Therapeutic Advances in Infection

View full text Add to dashboard Cite

show abstract

“…Furthermore, C. albicans was also implicated in depleting the abundance and diversity of other gastric fungi, which could potentially promote the rise of cancer in the stomach [ 85 ]. A recent report described a gastric cancer patient who had recently undergone cholecystectomy and presented with a C. albicans empyema that necessitated drainage and fluconazole treatment—underscoring the need to consider C. albicans in the pleural effusions of patients with malignancies [ 86 ].…”

Section: Candida Albicans In the Context Of Gastrointestinal...mentioning

confidence: 99%

A Putative Role of Candida albicans in Promoting Cancer Development: A Current State of Evidence and Proposed Mechanisms

et al. 2023

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Candida albicans is a commensal fungal species that commonly colonizes the human body, but it is also a pervasive opportunistic pathogen in patients with malignant diseases. A growing body of evidence suggests that this fungus is not only coincidental in oncology patients, but may also play an active role in the development of cancer. More specifically, several studies have investigated the potential association between C. albicans and various types of cancer, including oral, esophageal, and colorectal cancer, with a possible role of this species in skin cancer as well. The proposed mechanisms include the production of carcinogenic metabolites, modulation of the immune response, changes in cell morphology, microbiome alterations, biofilm production, the activation of oncogenic signaling pathways, and the induction of chronic inflammation. These mechanisms may act together or independently to promote cancer development. Although more research is needed to fully grasp the potential role of C. albicans in carcinogenesis, the available evidence suggests that this species may be an active contributor and underscores the importance of considering the impact of the human microbiome on cancer pathogenesis. In this narrative review, we aimed to summarize the current state of evidence and offer some insights into proposed mechanisms.

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Rare Case of Candida Parapsilosis Empyema Thoracis

Solomon

2023

Int J Med Stud

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BACKGROUND: This case report describes a patient with pleural empyema that grew Candida parapsilosis, an unexpected finding, especially in an immunocompetent individual with no prior surgery or trauma to the area. Candida empyema is a rare infection associated with mortality rates as high as 61.9%. METHODS: A 63-year-old male with a past medical history of pulmonary emboli was in his usual state of health when he developed worsening left-sided chest pain over 3 days, with associated shortness of breath and productive cough that was blood-tinged on occasion. Extensive imaging and a diagnostic thoracentesis confirmed an expanding left-sided parapneumonic effusion that was drained and found to grow Streptococcus anginosis and Candida parapsilosis. During his hospitalization, the patient also demonstrated increased alkaline phosphatase levels without abdominal pain or elevation in AST, ALT, or bilirubin, prompting further diagnostic imaging. Ultrasound of the abdomen showed a large, heterogeneous liver; follow-up CT scan, which was done without contrast due to worsening acute kidney injury, did not rule out liver masses. The patient’s clinical condition began to significantly improve following drainage of the pleural effusion and removal of the chest tube. After his kidney function returned to baseline, the patient was discharged with the remainder of his 18-day courses of amoxicillin-clavulanate and fluconazole, with a contrasted CT of the abdomen scheduled in the outpatient setting. CONCLUSION: This is an unusual case of fungal empyema, a severe manifestation of invasive candidiasis with a poor prognosis. Given the paucity of studies on Candida empyema, there is no definitive treatment for this deadly infection. A 2021 retrospective study of 81 patients with Candida empyema at two academic centers posited that optimal management included pleural drainage and fluconazole treatment. The same study found that 20% of Candida empyema originated from intra-abdominal sources. As for the patient in this case report, there remains the possibility that upcoming outpatient contrasted CT imaging of the abdomen will reveal the source of his infection.

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An Unusual Case of Candida albicans Empyema in Patient With Gastric Cancer and Colon Metastasis

Cited by 3 publications

References 8 publications

Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan

Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan

A Putative Role of Candida albicans in Promoting Cancer Development: A Current State of Evidence and Proposed Mechanisms

Rare Case of Candida Parapsilosis Empyema Thoracis

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