A rare presentation of isolated candidal hepatic abscess in a maintenance hemodialysis patient

IF 1.2 4区 医学 Q3 UROLOGY & NEPHROLOGY
Arunkumar Asokan, Judhajit Maiti, Gerry George Mathew, Varadharajan Jayaprakash
{"title":"A rare presentation of isolated candidal hepatic abscess in a maintenance hemodialysis patient","authors":"Arunkumar Asokan,&nbsp;Judhajit Maiti,&nbsp;Gerry George Mathew,&nbsp;Varadharajan Jayaprakash","doi":"10.1111/hdi.13172","DOIUrl":null,"url":null,"abstract":"<p>A 61-year-old female with diabetes and stage 5 chronic kidney disease on hemodialysis since 3 years via left brachiocephalic arteriovenous fistula presented with uncontrolled sugars, weight loss, and dysphagia. On evaluation, she was found to have an oral thrush with leucocytosis. Initial blood and urine cultures were sterile, and ultrasonography revealed hypoechoic lesions in the left lobe of the liver. She had high-grade fever followed by seizures on postadmission Day 10. Brain imaging and serum electrolytes were normal. Cerebrospinal fluid analysis was noncontributory, and urine culture revealed Candida non-albicans with elevated white blood cell counts. She was started on fluconazole; however, her clinical condition deteriorated, with hemodynamic instability. Repeat abdominal computerized tomography revealed increasing hypodense lesions in the left lobe of the liver with elevated beta D glucan levels. Percutaneous drainage of the abscess revealed no fungal elements. In view of clinical deterioration, amphotericin B was started, which resulted in clinical improvement. Clinician should have high index of suspicion for fungal etiology in hemodialysis patients presenting with liver abscess.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 4","pages":"460-463"},"PeriodicalIF":1.2000,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hemodialysis International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hdi.13172","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

A 61-year-old female with diabetes and stage 5 chronic kidney disease on hemodialysis since 3 years via left brachiocephalic arteriovenous fistula presented with uncontrolled sugars, weight loss, and dysphagia. On evaluation, she was found to have an oral thrush with leucocytosis. Initial blood and urine cultures were sterile, and ultrasonography revealed hypoechoic lesions in the left lobe of the liver. She had high-grade fever followed by seizures on postadmission Day 10. Brain imaging and serum electrolytes were normal. Cerebrospinal fluid analysis was noncontributory, and urine culture revealed Candida non-albicans with elevated white blood cell counts. She was started on fluconazole; however, her clinical condition deteriorated, with hemodynamic instability. Repeat abdominal computerized tomography revealed increasing hypodense lesions in the left lobe of the liver with elevated beta D glucan levels. Percutaneous drainage of the abscess revealed no fungal elements. In view of clinical deterioration, amphotericin B was started, which resulted in clinical improvement. Clinician should have high index of suspicion for fungal etiology in hemodialysis patients presenting with liver abscess.

一名维持性血液透析患者罕见地出现了孤立的念珠菌性肝脓肿。
一名 61 岁的女性患者患有糖尿病和慢性肾脏病 5 期,通过左侧肱脑动静脉瘘进行血液透析 3 年,出现糖分失控、体重减轻和吞咽困难。评估时发现她患有口腔鹅口疮并伴有白细胞增多。最初的血液和尿液培养均无菌,超声波检查发现肝脏左叶有低回声病变。入院后第10天,她出现高热,随后癫痫发作。脑成像和血清电解质正常。脑脊液分析无异常,尿培养显示为非白色念珠菌,白细胞计数升高。她开始服用氟康唑,但临床状况恶化,血流动力学不稳定。复查腹部计算机断层扫描发现,肝脏左叶的低密度病变不断增加,β D葡聚糖水平升高。脓肿经皮引流后未发现真菌成分。鉴于临床病情恶化,医生开始使用两性霉素 B,结果临床症状有所改善。对于出现肝脓肿的血液透析患者,临床医生应高度怀疑真菌病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Hemodialysis International
Hemodialysis International UROLOGY & NEPHROLOGY-
CiteScore
2.50
自引率
0.00%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信