Candida Perinephric Abscess: A Rare Presentation in a Trauma Patient

Background: The perinephric space is a closed anatomic space that plays an important role in limiting and transmitting disease processes. Perinephric abscess is an uncommon complication of peritonitis. The development of a perinephric abscess caused by Candida is also rare. In this case report we describe an unusual case of perinephric abscess caused by Candida in a trauma patient. To the best of our knowledge, this is the first case described, and as such, represents a novel case. Case Presentation: A 17-year-old male was impaled by a tree branch in a go-cart accident and presented to the emergency department with small bowel evisceration through the abdominal wall defect in his left upper quadrant. After he was assessed, he was taken to the operating room for emergency abdominal exploration. Surgical exploration revealed a large gastric laceration with diffuse peritonitis and massive contamination of the peritoneal cavity by gastric contents and minor trauma to the inferior pole of the spleen adjacent to the left kidney. After gastric repair, abdominal lavage, and staged abdominal wall reconstruction, the patient was treated with antibiotics for peritonitis. During the post-operative recovery period the patient became febrile with increasing white blood cell (WBC) count. Abdominal contrast-enhanced computed tomography (CT) revealed fluid accumulation in the left perinephric space, which was drained percutaneously and grew Candida albicans. Conclusion: Candida can cause perinephric abscess in patients with peritonitis and the clinical picture is usually indistinguishable from that caused by bacteria. A better understanding of the patient's risk factors and events as in this case, would presumably result in earlier diagnosis and prompt management.