A Subcutaneous Abscess Caused by Candida Krusei Infection: A rare Manifestation

Abstract

A1c 12.9; urinalysis was negative for urinary tract infection. She was diagnosed with diabetic ketoacidosis (DKA), perineal abscesses, and candida vulvovaginitis and admitted to MICU for aggressive management and close monitoring. She was started on the hospital DKA protocol, oral fluconazole, IV vancomycin, and IV Piperacillin tazobactam (Zosyn). Incision and drainage of the bilateral perirectal abscesses was performed without complications. Multiple wound cultures, including anaerobic, grew only Candida krusei [Figures 4, 5], confirming C. krusei subcutaneous abscess. She completed 7 days of empiric therapy with IV vancomycin and IV Zosyn; Fluconazole was discontinued and switched to IV Micafungin. She completed 14 days of IV Micafungin with a good response. Post-discharge outpatient follow-up revealed adequate healing of the perineal wounds. Abstract Candida is considered a normal microbiota of the gastrointestinal and genitourinary systems with a tendency for an invasive disease if the predisposing conditions exist. Mucocutaneous manifestations of Candida infection include the commonly encountered oropharyngeal thrush, vulvovaginitis, balanitis, intertrigo, paronychia, diaper dermatitis, and the rare chronic mucocutaneous candidiasis. Subcutaneous abscess due to Candida (albicans and non-albicans) is rare, with the literature available only in case reports. We report the first case of a subcutaneous perineal abscess due to C. krusie in a patient with poorly controlled diabetes without immune compromised conditions or a hematologic malignancy.