Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care
Pietro Addeo, Anne-Catherine Saouli, Marie Lorraine Woehl-Jaegle, Bernard Ellero, Elie Oussoultzoglou, Luc Marcellin, Philippe Bachellier
(University of Strasbourg, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Strasbourg, France)
Ann Transplant 2014; 19:64-67
Background: Fungal infections remain among the main causes of mortality in the chronically immunosuppressed liver transplant (LT) patient. Bacterial and fungal contamination of preservation fluid (PF), in which grafts are stored, represents a potential source of infection for recipients.
Case Report: A 54-year-old patient underwent LT for chronic alcoholic cirrhosis. Mycological culture of the liver PF was positive for Candida albicans. The patient received antimycotic prophylaxis for 4 weeks in absence of clinical and serological signs of infection. He was urgently readmitted 4 months later with hemobilia caused by an arterial pseudoaneurysm that was fistulized in the biliary anastomosis. After an unsuccessful embolization, arterial resection and reconstruction and a biliodigestive anastomosis were performed, with an uneventful postoperative course. Pathology found a mycotic arteritis of the graft artery. Mycotic culture of the arterial segment confirmed the presence of the same Candida albicans genotype previously isolated in the PF.
Conclusions: Mycotic arteritis is one of the possible complications of yeast contamination of PF. Surgeons and physicians involved in the care of LT patients should be aware of this potentially lethal complication and adopt all the available means for early detection.
Keywords: Hemobilia, arterial rupture, Mycotic aneurysms, Candida albicans, preservation fluid, Liver Transplantation