CASE PRESENTATION: A 62-year-old Japanese female with
obstructive jaundice, gastrointestinal
bleeding, and liver
metastasis from pancreatic
head cancer was given an implantable subcutaneous central venous port for nutrition and
chemotherapy administration. High
fever ensued on day 16 after the central venous port insertion and blood cultures revealed Candida albicans. Although the patient was given 300 mg/day of
fosfluconazole according to the suggestion of the infection control team, she died from
respiratory failure. Postmortem computed tomography revealed findings consistent with
acute respiratory distress syndrome, suggesting that the patient's course was complicated by
catheter-related
sepsis. Autopsy revealed a subcutaneous
abscess around the port, from which C. albicans was cultured. However, no
catheter-adherent
thrombus,
thrombosis of the great central veins, or endocardial vegetations were detected in the patient. Histological analysis revealed scattered
abscesses in several organs including lungs and kidneys. Hyaline membrane formation and Candida colonies were found in the lungs. The central venous port tube, together with the part of the subclavian vein into which it had been inserted, was involved in an intraluminal
fibrin thrombus containing neutrophils and macrophages, indicating that the
thrombus existed while the patient was alive. Histopathological examination following use of the
periodic acid-
Schiff reagent and the Grocott
stain revealed scattered Candida in the
thrombus.
CONCLUSIONS: