Prolong Fever in Elderly Man with Anemia, Lymphopenia, Thrombocytopenia, Ascites, Hypoalbuminemia, Hepatitis and Renal Failure Following Prostate Surgery: Emerging Invasive Fungal Infections By Candida Albicans, Sepedonium Species and Candida Tropica

A 78-years-old male had fever for two weeks with appetite loss and weight loss. He had hypertension and chronic kidney disease. He underwent transurethral resection of prostate one month ago for benign prostatic hypertrophy. It was complicated by urinary tract infection due to Klebsiella pneumoniae two months prior to fever. Physical examination was unremarkable except mild anemia. Blood examination revealed anemia, lymphopenia, thrombocytopenia, transaminitis, high serum creatinine and high inflammatory markers (ESR, CRP and procalcitonin). Studies on imaging (chest radiograph, CT scan chest, abdomen and pelvis, ultrasound abdomen) were normal apart from gall stone and ascites. Candida albicans was detected in urine culture; parenteral voriconazole for two weeks followed by oral voriconazole for 3 weeks was given. However, fever persisted and bone marrow examination was proceeded. Sepedonium species was grown in fungal culture from bone marrow; and Candida tropicalis was identified in urine. He recovered with Amphotericin B therapy for 3 weeks followed by 8 weeks course of oral voriconazole. Awareness of emerging invasive fungal infections in patient with prolong fever is highlighted.