Fungal Seeding of Deep Venous Thrombosis: A Source of Recurrent Fungemia and Role of IR in Treatment

Background: Anticoagulation is the cornerstone in the treatment of deep vein thrombosis. However, the treatment of septic deep vein thrombosis is controversial. Thrombectomy is suggested as one of the means of source control in patients with colonized deep vein thrombosis as the source of recurrent fungemia.

Case: A 78-year-old male with a past medical history of bullous pemphigoid and Candida glabrata infection with suspected urinary source. The patient presented 2 months later with sepsis and Candida glabrata fungemia. No specific source of candidemia was identified with negative workup for endocarditis and ophthalmitis. The patient had persistent fungemia on follow-up blood culture despite treatment with IV micafungin. Of note, the patient had a recent hospitalization for bilateral deep venous thrombosis (DVT). There was concern for fungal seeding of thrombus as WBC study showed increased uptake in the bilateral lower extremities. The patient underwent a bilateral DVT thrombectomy with a positive thrombus culture. One week after DVT thrombectomy, blood cultures were negative.

Discussion: Though rare, in the absence of a source of fungemia and with the presence of DVT, fungal seeding of the thrombus should be considered. Mechanical thrombectomy of the thrombus should be considered as a means of source control.

Publication History

Article published online:
09 February 2023