Septic Candida krusei thrombophlebitis of inferior vena cava with persistent fungemia successfully treated by new antifungal agents

Abstract

Treatment of Candida krusei fungemia can be problematic. We describe a 44-year-old critically ill, non-immunocompromised patient who had persistent Candida krusei fungemia complicated with septic thrombophlebitis of the inferior vena cava. Successful treatment was achieved by parenteral caspofungin followed by prolonged oral voriconazole. Persistent fungemia in the face of ongoing antifungal therapy and prompt removal of central line should alert physicians to the diagnosis of septic thrombophlebitis. Though combined therapy with amphotericin B and surgical intervention probably remains the treatment of choice, prolonged new antifungal agents, which have better efficacy, tolerability and bioavailability, may be a useful alternative where the central veins are relatively inaccessible or the patient is at high operative risk.