A rare case of Candida parapsilosis pneumonia in an immunocompetent patient

Abstract

Introduction: The presence of fungus in an immunocompetent host is usually disregarded as a mere contaminant, as it can be a commensal organism of the skin, gastrointestinal, urogenital, and respiratory tract. Hence, its growth in cultures has to be interpreted within a clinical context. This case illustrates the challenges experienced when diagnosing Candida parapsilosis necrotizing pneumonia, and the importance for considering candida pneumonia as a differential diagnosis for an immunocompetent patient. After a thorough literature review, we would like to present the first case report of C. parapsilosis causing necrotizing pneumonia in an immunocompetent patient. Case Report: We present a case involving a middle-aged smoking male who presented with respiratory and metabolic abnormalities and was found to have necrotizing pneumonia. He was managed for severe sepsis with lactic acidosis, respiratory failure, and severe acute kidney injury (AKI), which improved with broad spectrum antibiotics and fluids. These conditions improved; however, his respiratory distress did not despite a prolonged course of antibiotics. This led to a workup for other causes of necrotizing pneumonia, after which cultures revealed the growth of C. parapsilosis. He was then started on antifungals and subsequently improved. Conclusion: Candida necrotizing pneumonia is a rare disease for an immune-competent individual; however, chronic lung damage in the setting of a smoking history may make individuals more susceptible. This case illustrates the challenges associated when dealing with such a case, and it is the team’s hope that publishing this case will add to awareness. Additionally, this can contribute to improved antibiotic stewardship and earlier diagnosis which will hopefully lead to a shorter hospital stay and improved morbidity and mortality.