Hu W, Lin X, Qian M, Du TM, Lan X. Treatment of Candida albicans liver abscess complicated with COVID-19 after liver metastasis ablation: A case report. World J Gastrointest Oncol 2023; 15(7): 1311-1316 [PMID: 37546559 DOI: 10.4251/wjgo.v15.i7.1311]
Corresponding Author of This Article
Xi Lan, MM, Doctor, Department of Oncology, Chengdu Seventh People’s Hospital, No. 1188 Shuangxing Street, Shuangliu District, Chengdu 610000, Sichuan Province, China. lanxi2020ys@163.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jul 15, 2023; 15(7): 1311-1316 Published online Jul 15, 2023. doi: 10.4251/wjgo.v15.i7.1311
Treatment of Candida albicans liver abscess complicated with COVID-19 after liver metastasis ablation: A case report
Wen Hu, Xi Lin, Meng Qian, Tao-Ming Du, Xi Lan
Wen Hu, Meng Qian, Xi Lan, Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
Xi Lin, Department of Oncology, Yanting County People’s Hospital, Mianyang 621600, Sichuan Province, China
Tao-Ming Du, Department of Radiology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
Author contributions: Hu W contributed to the writing of the original draft; Qian M and Lin X were involved in editing the manuscript; Du TM participated in manuscript editing and provided computed tomography images; Lan X participated in manuscript writing and review.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xi Lan, MM, Doctor, Department of Oncology, Chengdu Seventh People’s Hospital, No. 1188 Shuangxing Street, Shuangliu District, Chengdu 610000, Sichuan Province, China. lanxi2020ys@163.com
Received: April 15, 2023 Peer-review started: April 15, 2023 First decision: May 4, 2023 Revised: May 14, 2023 Accepted: May 26, 2023 Article in press: May 26, 2023 Published online: July 15, 2023
Abstract
BACKGROUND
Liver interventional surgery is a relatively safe and minimally invasive surgery. However, for patients who have undergone Whipple surgery, the probability of developing a liver abscess after liver interventional surgery is very high. Fungal liver abscess has a high mortality rate, especially when complicated with malignant tumors, diabetes, coronavirus disease 2019 (COVID-19) and other complications. Fungal liver abscess is rare, and there are no guidelines or expert consensus on the course of antifungal therapy.
CASE SUMMARY
A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy. Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy, followed by ablation of the liver metastasis. After half a month of liver metastasis ablation, the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection. The results of pus culture showed Candida albicans, which was sensitive to fluconazole. The patient underwent percutaneous catheter drainage, antifungal therapy with fluconazole, and antiviral therapy with azvudine. During antifungal therapy, the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy. Oral fluconazole was continued for 1 wk outside the hospital, and fluconazole was used for a total of 5 wk. The patient recovered well and received 4 cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan after 2 mo of antifungal therapy.
CONCLUSION
Effective treatment of Candida albicans liver abscess requires early detection, percutaneous catheter drainage, and 5 wk of antifungal therapy. Meanwhile, complications such as COVID-19 should be actively managed and nutritional support should be provided.
Core Tip: Fungal liver abscess is rare and has a high mortality rate, especially when combined with malignant tumor, diabetes, coronavirus disease 2019 (COVID-19), and other complications, which increase the difficulty of treatment. However, there are no guidelines or expert consensus on the course of antifungal drugs. We present a rare case of Candida albicans liver abscess complicated with COVID-19 after ablation of liver metastasis from pancreatic head cancer. The patient was successfully cured after percutaneous catheter drainage, antifungal therapy, therapeutic management of comorbidities and nutritional support.
