title: Conservative management of Candida infection of prosthetic aortic graft by means of caspofungin and fluconazole alone.
abstract: Candida albicans infections after prosthetic graft implantation due to acute aortic dissection are rare. A combination of surgical resection and lifelong antifungal drug therapy is the gold standard for treatment of aortic graft infection, yet surgical interventions are associated with high mortality rates. Herein, we present the case of a 57-year-old man who presented with peripheral microembolism due to late-onset C. albicans infection of a prosthetic graft of the thoracic aorta, which was diagnosed by positron emission tomographic imaging. Given the high risk of reoperation, the patient was treated with intravenous caspofungin for 4 weeks, followed by oral administration of fluconazole. During a follow-up of 500 days, he remained asymptomatic, with slightly elevated inflammatory markers. This case suggests that in some instances, particularly in patients with high operative risk, Candida prosthetic graft infection can be managed conservatively with antifungal therapy alone. However, such an approach should be applied with caution and necessitates close follow-up on a long-term basis.
authors.affiliation: Department of Internal Medicine III, University of Cologne, 50937 Cologne, Germany. lukas.motloch@uk-koeln.de
authors.forename: Lukas J
authors.initials: LJ
authors.lastname: Motloch
authors.forename: Dennis
authors.initials: D
authors.lastname: Rottlaender
authors.forename: Turak
authors.initials: T
authors.lastname: Darabi
authors.forename: Insa
authors.initials: I
authors.lastname: Joost
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage*; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000382:microbiology; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D055666:Lipopeptides; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077336:Caspofungin