MON-659 I Know What You-TI Can-Did-a Last Summer: A Rare Scenario of Fungemia Resulting from Urinary Tract Translocation From Diabetic Neuropathy

Abstract Disclosure: H. Tranton Junior: None. J.A. Vu: None. Description: In the context of type II diabetes management, the notion of Candida albicans infection is a frequent concern. Fungemia as a result of infection is an emergent condition that requires prompt medical treatment. This case concerns a 59-year-old male, who had no established primary care and was found to have Candida fungemia from what is likely a novel source. The patient presented to the hospital due to lethargy, lower extremity weakness, high grade fever, and vomiting going on two weeks. A1c at admission was found to be 14.9. He also reported ongoing urinary incontinence during that time, wearing adult diapers. Straight catheterization was remarkable for output of 2 liters cloudy urine remarkable for glucose, fungi, budding yeast, ketones, and leukocyte esterase. CT-imaging following bladder decompression showed significant bilateral hydronephrosis, with no presence of fungal obstruction in bladder. Eventually blood cultures were remarkable for 2/2 candida albicans, and patient was started on fluconazole treatment with eventual transition to caspofungin due to transaminitis. Curiously enough, patient's history was not remarkable for any of the traditional niduses of candidemia. Patient had no history of injection drug use, no recent/previous hospitalizations, no central lines, no surgeries, no dialyses. Though patient was wearing diapers prior to admission, patient did not report any rash or abrasions in the groin area. Physical exam of the area was also grossly unremarkable for any abrasion, rash, scarring, balanitis, nor inflammation. Full workup for candidemia was performed including ophthalmologic examination for ocular candida chorioretinitis, TEE for fungal valvular endocarditis, and MRI to evaluate for fungal abscess. All studies were unremarkable. Discussion was had with the infectious disease team, and with all evaluations being unremarkable, the only likely route of candidemia was translocation from the bladder in the setting of severe diabetic neuropathy resulting in severe urinary retention. A route of disease that, while possible physiologically, is exceedingly uncommon. Patient was eventually discharged with insulin therapy, flomax, and full course of fungal treatment. Following appropriate established outpatient care, candidemia was resolved and diabetes was more controlled with repeat A1c found to be 8.3. Patient still has continued urinary retention with urologic follow-up. Conclusion: Though candida UTI and candidemia are frequent concerns for patients with uncontrolled diabetes, candidemia as a result of bladder translocation is fairly novel/rare from an academic standpoint. Presentation: Monday, July 14, 2025