Case
A 45-year-old Japanese woman receiving parenteral nutrition via a
peripherally inserted central catheter (PICC) was hospitalized for
hypopharyngeal cancer. Blood culture detected Candida albicansand plain computed tomography (CT) revealed gas production surrounding
the catheter in the brachiocephalic vein (Figure 1a ). We
extracted the PICC and administered fosfluconazole, but candidemia
persisted for 2 weeks. A follow-up contrast-enhanced CT showed the
disappearance of gas while a blood clot remained (Figure 1b ).
Considering candida biofilm-related thrombophlebitis, we additionally
administered micafungin and the recurrent candidemia promptly withdrew
with a good clinical course thereafter.
Biofilm-associated candidemia is rare but possibly results in a high
mortality rate estimated at at aroud 70% [1]. Candida biofilm
provides resistance to azole-class antifungals, wherein treatment with
echinocandins or amphotericin B is reportedly promising [2].
Clinical course of the present case suggested the effectiveness of
micafungin treatment in candidal thrombophlebitis, with which biofilm
formation was associated. In case candidemia persisted with thrombus
formation, a candida biofilm targeted therapy may be required.