CANDIDA ARTERITIS - ARE GI ENDOSCOPIC PROCEDURES A SOURCE OF VASCULARINFECTIONS

A 53-year-old woman, 11 years after a renal transplant on chronic immu nosuppression, presented with a sudden onset of a painless left groin mass. Ultrasound revealed a 3 cm common femoral artery pseudoaneurysm and a 3 cm saccular aneurysm of the infrarenal aorta, Operative repair was excision and patch angioplasty of the aortic aneurysm with intern al iliac artery and interposition grafting of the femoral artery aneur ysm with saphenous vein. Postoperatively, Candida albicans was identif ied in the aortic and common femoral arterial cultures. Candida infect ions often occur in patients with impaired cellular immunity due to se eding from urinary tract infections, vascular catheters, or manipulati on of the gastrointestinal tract Our patient, without any prior histor y of a fungal infection, had undergone a colonoscopy 3 weeks earlier. Without any other possible source being identified, the proposed mecha nism for fungal entry into the vascular system was via the gastrointes tinal tract, with seeding from the portal venous system, The exact med ical and surgical management of these patients remains undefined, and a transplant vascular registry is really needed. However, immunocompro mised solid organ transplant recipients undergoing gastrointestinal en doscopic procedures may be at a greater risk for the development of su bsequent septicemia. Further reports are really needed to confirm the possible need in these patients for both periprocedural antibiotic and antifungal prophylactic coverage.