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.