Candida albicans necrotizing fasciitis following elective surgery

Abstract

Necrotizing fasciitis is a potentially fatal soft tissue infection that requires prompt clinical suspicion, pharmacological and surgical interventions. Bacterial pathogens, such as beta-hemolytic streptococcus and Staphylococcus aureus, are the main etiology of necrotizing fasciitis, however, rare cases caused by fungal pathogens, such as Candida albicans, have been reported following trauma. Here, we present the first case of C. albicans necrotizing fasciitis following an elective surgical procedure in an immunocompetent adult.

Keywords: Candida; Immunocompromised; Necrotizing fasciitis.

Fig. 1

Computed Tomography of the abdomen. Coronal (Panel A), sagittal (Panel B), and axial (Panel C and D) sections of the abdomen demonstrating marked edema, extensive fat stranding and soft tissue emphysema of the left abdominal wall (arrows).

Fig. 2

Histopathology demonstrating Candida albicans necrotizing fasciitis. At low power (Panel A, 40X magnification), slides stained with hematoxylin and eosin revealed necrotic tissue with a blue-staining infiltrate traveling along tissue planes. At higher power (Panel B, 400X magnification) the infiltrate is revealed to consist not of inflammatory cells but rather budding yeast forms and pseudohyphae (circles), confirming fungal tissue invasion. Slides stained using Gomori's methenamine silver (GMS) impregnation technique (Panel C, 40X magnification; Panel D, 400X magnification) highlighted the fungal elements, which are morphologically consistent with Candida albicans. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)