Fungal endotipsitis: A case report and literature review

Abstract

Endotipsitis is a broad term used to describe sustained and clinically significant bacteremia or fungemia from a suspected vegetation or thrombus within the transjugular intrahepatic portosytemic shunt (TIPS) device. Endotipsitis is a rare infection in post-TIPS patients and given the diagnostic challenges, there is a need to establish formal diagnostic criteria. Bacterial causes of endotipsitis have been well documented in the literature, but few fungal-associated etiologies have been published to date. With this paucity of data, treatment strategies are lacking regarding the role of antifungal duration, the aggressiveness of medical therapy, and the role of liver transplantation. We present a case of Candida-associated endotipsitis and suggest a need for preferred management strategies in an effort to decrease the significant morbidity and mortality of the infection.