Fatal septic shock caused by candida myocarditis associated with malignant lymphoma and Epstein-Barr virus mediated disorder

Salah A. M. Said, Bart J. F. Liebrand, Nersing Bansraj, Erik Eijken

.

DOI: 10.4236/ojim.2011.12007                

Abstract

A 60-year-old man with known epilepsy was admitted to our hospital due to hypotension, fever and arrhythmia. He was treated medically and myocardial infarction was ruled out. Treatment of septic shock was established according to the guidelines of the early goal-guided therapy including vasopressors, inotropic agents, mechanical ventilation, and hemofiltration in combination with empirical treatment with antimicrobial drugs and hydrocortisone. The patient’s condition deteriorated rapidly into multiorgan failure resulting in a fatal outcome. Antemortem blood cultures were sterile. Autopsy findings were compatible with Epstein-Barr virus mediated lymphoproliferative disorder, malignant lymphoma, disseminated candidiasis and candida myocarditis. Post-mortem blood and tissue cultures were positive for growth of candida glabrata and candida albicans, respectively. The post-mortem examination documented Epstein-Barr virus mediated lymphoproliferative disorder and malignant small cell lymphoma associated with candida myocarditis. Prior to death, the patient did not receive antiviral or antifungal treatment. Fatal candida myocarditis associated with septic shock secondary to disseminated candidiasis in a 60-years old male patient with prior unknown immune compromised state caused by Epstein-Barr virus mediated lymphoproliferative disorder and malignant lymphoma is described.

Keywords

Septic Shock; Candida Myocarditis; Epstein-Barr Virus Mediated Lymphoproliferative Disorder; Malignant Lymphoma; Arrhythmia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mason, J.W., Trehan, S. and Renlund, D.G. (2007) Myocarditis. In: Hall, J.B., Schmidt, G.A. and Wood, L.D.H. Eds., Principles of Critical Care, Springer, London, 1313-1334.
[2]	Molero, G., Díez-Orejas, R., Navarro-García, F., Monteoliva, L., Pla, J., Gil, C., Sanchez-Perez, M. and Nombela, C. (1998) Candida albicans: Genetics, dimorphism and pathogenicity. International Microbiology, 1, 95-106.
[3]	Bennett, J.E. (1990) Mycosis. In: Maddell, G.L., Douglas, R.G. and Bennett, J.E. Eds., Principles and Practice of Infectious Diseases, Churchill Livingstone Inc Publi- cations, New York, 1942-1954.
[4]	Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E. and Tomlanovich, M. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. The New England Journal of Medicine, 345, 1368-1377. doi:10.1056/NEJMoa010307
[5]	Abbas, A.A.H. and Tapp, H.E. (2005) Disseminated candida infection in children treated for cancer: A report of five cases and review of the literature. Haema, 8, 497-503.
[6]	Dennert, R., Crijns, H.J. and Heymans, S. (2008) Acute viral myocarditis. European Heart Journal, 29, 2073-2082. doi:10.1093/eurheartj/ehn296
[7]	Baddley, J.W., Benjamin, D.K., Patel, M., Miro, J., Athan, E., Barsic, B., Bouza, E., Clara, L., Elliott, T., Kanafani, Z., Klein, J., Lerakis, S., Levine, D., Spelman, D., Rubeinstein, E., Tornos, P., Morris, A.J., Pappas, P., Fowler Jr, V.G., Chu, V.H. and Cabell, C. (2008) Candida infective endocarditis. European Journal of Clinical Microbiology & Infectious Diseases, 27, 519-529. doi:10.1007/s10096-008-0466-x
[8]	Ellis, M.E., Al-Abdely, H., Sandridge, A., Greer, W. and Ventura, W. (2001) Fungal endocarditis: Evidence in the world literature, 1965-1995. Clinical Infectious Diseases, 32, 50-62. doi:10.1086/317550
[9]	Nieuwenhuijs, D.J.F. and Zandstra, D.F. (2008) Bacterial myocarditis as a cause of fatal septic shock. The Netherlands Journal of Critical Care, 12, 285-287.
[10]	Ihde, D.C., Roberts, W.C., Marr, K.C., Brereton, H.D., McGuire, W.P., Levine A.S. and Young, R.C. (1978) Cardiac candidiasis in cancer patients. Cancer, 41, 2364-2371. doi:10.1002/1097-0142(197806)41:6<2364::AID-CNCR2820410640>3.0.CO;2-W
[11]	Franklin, W.G., Simon, A.B. and Sodeman, T.M. (1976) Candida myocarditis without valvulitis. American Journal of Cardiology, 38, 924-928. doi:10.1016/0002-9149(76)90805-5
[12]	St?llberger, C., Preiser, J. and Finsterer, J. (2004) Histological detection of intramyocardial abscesses in candida sepsis mimicking left ventricular non-compaction/hypertrabeculation on echocardiography. Mycoses, 47, 72-75.
[13]	Einarsdottir, H.M., Danielsen, R. and Gottfredsson, M. (2002) Successful treatment of Candida glabrata myocarditis with voriconazole. Scandinavian Journal of Infectious Diseases, 34, 778-780. doi:10.1080/00365540260348635