Pneumonia caused by Enterococcus faecalis and tropical candida in a maintenance hemodialysis patient concomitant with COVID-19: A case report and literature review

Abstract

Rationale: Maintenance hemodialysis (MHD) represents a crucial form of renal replacement therapy for patients suffering from end-stage renal disease. These MHD individuals are especially susceptible to pulmonary infections due to compromised immune defenses. High throughout metagenomic sequencing technologies allow for the precise identification of pathogens at the genetic level, leading to personalized treatment plans that improve patient outcomes. This case represents the first reported instance of a mixed pulmonary infection with Enterococcus faecium and Candida tropicalis in a MHD man concomitant with coronavirus disease 2019 (COVID-19), which responded well to anti-infection treatment. The objective of this article is to enhance comprehension of concurrent pulmonary infections in individuals undergoing MHD and to enhance the capability for prompt detection and differential diagnosis. Patient concerns: A MHD man who developed COVID-19 and subsequently experienced recurring chills, high fever, coughing, expectoration, and difficulty breathing after a week. Laboratory analyses indicated elevated markers of inflammation, while a computed tomography scan detected inflammation in both of the patient’s lungs. Diagnosis: Chronic kidney disease stage V, pneumonia, and COVID-19. Interventions: Following initial treatment with a wide range of antibiotics guided by blood and sputum cultures, there was no improvement in the patient’s health. Further examination of the bronchoalveolar lavage fluid through metagenomic next-generation sequencing revealed the exact pathogens responsible for the infection. Outcomes: We lead to a tailored antimicrobial treatment plan that significantly alleviated the patient’s pulmonary inflammation and overall symptoms. The patient’s body temperature reverted back to its normal range, with an absence of any notable coughing or sputum generation. Additionally, there was a marked decrease in inflammatory markers. Furthermore, a chest computed tomography scan exhibited enhanced absorption of pulmonary lesions in comparison to previous scans. Lessons: The greater risk and mortality of pneumonia in MHD patients have not received adequate attention. Such uncommon cases require heightened awareness among clinicians to prevent delays in diagnosis and treatment.