RESUMEN
Infection with Scedosporium species is associated with a significant morbidity and mortality and is becoming increasingly common, especially in immunocompromised patients. We describe the presentation and successful management of an immunocompromised patient with Scedosporium apiospermum infection of the upper urinary tract system, a rare disease manifestation. The current literature on urinary tract scedosporiosis is further reviewed with emphasis on treatment options and limitations of current antifungal therapy.
Asunto(s)
Micosis/epidemiología , Scedosporium/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Adulto , Antifúngicos/uso terapéutico , Trasplante de Médula Ósea/efectos adversos , Femenino , Humanos , Huésped Inmunocomprometido/efectos de los fármacos , Itraconazol/uso terapéutico , Masculino , Micosis/microbiología , Pirimidinas/uso terapéutico , Scedosporium/aislamiento & purificación , Triazoles/uso terapéutico , Infecciones Urinarias/epidemiología , Voriconazol/uso terapéuticoRESUMEN
Staphylococcus aureusbacteraemia (SAB) remains a complex disease with a high associated morbidity and mortality, especially when it is able to establish an occult nidus safe from antimicrobial eradication. Without rapid identification and intervention, the nidus can cause persistent relapse of disease, morbidity and mortality. Having a high clinical suspicion for the foci of occult S. aureus is important, and awareness of potential sites of infection is critical and can be life-saving.We present a unique case of a 65-year-old man with end-stage renal disease receiving haemodialysis who developed septic shock from SAB. Despite 18 days of appropriate antibiotics, the patient had persistent high-grade bacteraemia until his gall bladder was ultimately percutaneously drained. The day after drainage, he cleared his blood cultures, although he ultimately passed away as he decided to transition his care to focus on comfort measures.