title: An unusual case of deep candidosis presenting as an infiltrating tumour of the chest wall.
abstract: A 45-year-old man presented with an unclear rapidly growing, infiltrating tumour of the anterior chest wall. Biopsies were non-specific, serologies remained unremarkable. Shortly after admission the patient developed blurred vision. Ophthalmoscopical findings were typical of candida endophthalmitis. Meanwhile, the tumour continued to grow. When it was resected, hyphae of Candida albicans were yielded from the tissue revealing it as a manifestation of deep candidosis. The infection had probably been acquired endogenously during abdominal surgery for early stage rectal carcinoma which the patient had undergone several weeks ago and which was followed by an unexplained fever. Interestingly, deep candidosis presenting as an infiltrating tumour of the anterior chest wall often combined with candidal endophthalmitis has been described almost exclusively in intravenous drug users after the injection of contaminated heroin [Collignon PJ, Sorrell TC. Disseminated candidiasis: evidence of a distinctive syndrome in heroin abusers. Br Med J (Clin Res Ed) 1983;287(6396):861-2; Dupont B, Drouhet E. Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients. J Infect Dis 1985;152(3):577-91; Bisbe J, Miro JM, Latorre X, Moreno A, Mallolas J, Gatell JM, et al. Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review. Clin Infect Dis 1992;15(6):910-23.]. Why the tumours only develop on the anterior thoracic wall is unknown. To our knowledge this is the first case described in literature in which endogenously acquired deep candidosis manifested as an infiltrating tumour in a patient who was neither immunosuppressed nor had a history of intravenous drug use.
authors.affiliation: Charité--University Medicine Berlin, Campus Benjamin Franklin, Medical Clinic I, Hindenburgdamm 30, 12200 Berlin, Germany. camilla.rothe@charite.de <camilla.rothe@charite.de>
authors.forename: Camilla
authors.initials: C
authors.lastname: Rothe
authors.forename: Ralf
authors.initials: R
authors.lastname: Ignatius
authors.forename: Martin
authors.initials: M
authors.lastname: Zeitz
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D035441:Thoracic Wall / Q000473:pathology*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole