Candida auris pericarditis, the second reported case worldwide, was successfully treated in a hemodialysis patient using early surgical drainage and liposomal amphotericin B.
This case highlights the importance of considering fungal etiologies like C. auris in high-risk patients with pericardial effusion and the need for early surgical drainage and targeted therapy.
Absolute Event Rate: 0% vs 0%
Introduction: Disseminated Candida auris infection presenting with fungal pericarditis is a life-threatening infection typically associated with immunosuppression, cardiac surgery, or prolonged antibiotic use. Fungal species comprise less than 1% of pericardial infections, with Candida auris—an emerging multidrug-resistant yeast—rarely implicated; only one documented case of Candida auris pericarditis has been reported in the literature, resulting in death. Description: A 54-year-old man with end-stage renal disease (ESRD) on hemodialysis due to IgA nephropathy, type 2 diabetes, and recent diagnosis of endocarditis at an outside hospital presented with shortness of breath and anemia (hemoglobin 6.0 g/dL). His medical history included ulcerative colitis (post-colectomy), L4-L5 osteomyelitis, stroke, and recent PFO closure. Echocardiography revealed a moderate pericardial effusion, leading to a left anterior thoracotomy with pericardial window creation. Intraoperative pericardial and pleural fluid were cloudy, with WBC 1000/mm3 (neutrophil predominance). Gram stain was negative; cultures grew C. auris. Blood cultures remained sterile. The patient was initially started on micafungin, but due to lack of clinical response, therapy was switched to liposomal amphotericin B while awaiting susceptibility results. He subsequently improved and remains hospitalized under close supervision monitoring. Discussion: This is the second reported case of C. auris pericarditis worldwide. Risk factors included ESRD, cardiac hardware, and broad-spectrum antibiotic use. The infection remained localized without fungemia, highlighting the importance of direct sampling. Early surgical drainage and rapid microbiological identification allowed for prompt targeted treatment. This case underscores the need to consider fungal etiologies in high-risk ICU patients with pericardial effusion and highlights C. auris as an emerging critical care threat that requires enhanced surveillance and infection control measures. Sources: (Ruiz-Gaitán et al., JMM Case Rep 2018). (Chowdhary et al., PLoS Pathog, 2016; CDC, 2024).
Albittar et al. (Sun,) reported a other. Candida auris pericarditis, the second reported case worldwide, was successfully treated in a hemodialysis patient using early surgical drainage and liposomal amphotericin B.