Prescribe a previously healthy 4-year-old male with complete immunization schedule for his age.
Three weeks after a high respiratory condition, she was diagnosed with Guillain syndrome and was admitted to the pediatric intensive care unit.
The patient received broad-spectrum antibacterial treatments (piperacillin/ Klebsiella pneumoniae infection due to mechanical ventilation associated pneumonia for 8 days, without microbiological isolation, and then meropenem for 10 days due to central venous bacteremiaC.
During her stay in the intensive care unit, she underwent a permanent urinary catheter and underwent tracheostomy.
On the fifth day of treatment with meropenem, the patient remained febrile, so a fungal infection was diagnosed.
C. tropicalis was isolated in urine and blood.
Urine stain revealed yeasts and urine culture revealed 30,000 C. tropicalis with MIC ≤ 0.25g/mL for amphotericin B and fluconazole caspoline ≤ 0.25g/mL.
The strain was identified by CHROMagar; sugar assimilation was not performed.
C. tropicalis was confirmed by Vitek 2® 2 compact 60 (Biomérieux) and MIC breakpoints were obtained by broth microdilution according to CLSI.
Treatment was initiated with amphotericin B deoxycholate 1 mg/kg/day.
Fever decreased on the third day and hemocultives became negative on the fourth day of therapy.
Amphotericin B deoxycholate was well tolerated, maintaining normal renal function.
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On the seventh day of treatment a renal and urinary tract ecotomography was performed, which showed both kidneys with acute inflammatory changes: the right kidney measured 9 x 3.6 x 3.1 cm; the left bladder showed a mild lesion x 3.5 cm.
After completing 40 mg/kg of amphotericin B deoxycholate, and due to persistence of the fungus, resection was performed by cystoscopy.
Macroscopically, the tissue had a white color and soft consistency.
The histopathological study with hematoxylin-eosin staining reported the mucosa with stromal edema, erosions of the transitional epithelium and presence of lymphocytes and macrophages compatible with a chronic bladder cyst.
No special staining for parasites was performed.
The urocultiva was negative after resection of the fungus, so antifungal was suspended 48 h after surgery, with post-surgical ultrasound without evidence of fungus.
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The patient was admitted to intensive care unit for 16 days and then admitted to pediatric neurology unit for three months.
The patient was discharged without stenosis and followed up on outpatient follow-up.
