mixed fungal pneumonia and candidemia in immunocompromised patient -case presentation and literature...
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Mixed Fungal Pneumonia and Candidemia in Immunocompromised Patient -Case Presentation and Literature Review
Dr. Hythum Salah H. Mohamed –NGHA-KAMC-Riyadh-May 2015
Case Description
73 years old female – D.O.A 2nd April 2015 . Admitted with fever and fatigability for 3 days . PMH of HTN , old CVA ,DVT ,Osteoporosis and she is recently
diagnosed with Multiple Myeloma . She is on chemotherapy . Examination -- vital signs on admission was normal apart from
tachypnea . abdominal tenderness but soft abdomen .
Pt received Tazocin + i.v Fluid and septic workup was done ( Sepsis ?) .
After 2 days of ER stay Pt deteriorated and developed shortness of breath and being hypoxic with decrease level of consciousness GCS 13/15 with decrease air entry in the chest mainly in the right side .
Pt transferred to the ICU . She required Mechanical Ventilation and later inotropes and she
developed acute renal failure and liver injury (Failure ) .
Blood and Respiratory cultures came positive after day 12 -4-2015 .
Despite treatment unfortunately she died on day 20 -4-2015 .
Respiratory C/S (BAL) showed Aspergillus Flavus in multiple cultures in days 11, 12,15 and 21 -4 -2015 .
Respiratory C/S (BAL) showed Candida Tropicalis in multiple cultures in days 11, 12 ,15 and 21-4 -2015 .
Blood culture showed Candida Tropicalis , pan sensitive in 12th -4-2015 .
Aspergillus glactomanan positive in 12th -4-2015 . Others was negative , Influnza , MERS-Cov and AFB . Rectal swab positive for carbapenem resistant klebsiella
pneumoniae .
Antimicrobials Days
Tazocin+Vancomycin+Metrindazole
2-4 - 2015
Ostelmvir +Meropenenm 5 -5-2015
Stop all and start Ceftriaxone 7-4-2015
Voriconazole 10-4-2015
Voric+Meropenem+Vancomycin 13-4-2015
Added Anidulafungin 14-4-2015
Anidulaf+Voric+Merope+Vancomycin
15-4-2015
DC Andiulf and Voric and Vancomycin
19-4-2015
Start Amphotrc Lipid complex+Merop+
Antimicrobials
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