ACALCULOUS CANDIDAL CHOLECYSTITIS - A PREVIOUSLY UNRECOGNIZED COMPLICATION AFTER CARDIAC TRANSPLANTATION

Acalculous cholecystitis is a life-threatening complication in critica lly ill surgical patients. Whereas Candida albicans and Torulopsis gla brata have been reported as the primary pathogens in 14 previous cases of acalculous cholecystitis, we report the first case of Candida para psilosis as a biliary pathogen in a patient after cardiac transplantat ion. Although cardiac transplant recipients often have many of the ris k factors for acalculous candidal cholecystitis, including major surge ry, immuno-suppression, antibiotic therapy, parenteral nutrition, and prolonged intensive care unit stay, this entity has not been previousl y reported in the cardiac transplant population, Although rare, acalcu lous candidal cholecystitis is associated with very high morbidity and a mortality rate of 40%. Early diagnosis necessitates an aggressive a pproach to the critically ill patient with abdominal complaints. Promp t drainage or cholecystectomy, if possible, represent the mainstays of therapy and offer the greatest chance for survival.