LAUSR

A 4-year-old girl with Crohn disease (CD) was repeatedly hospitalized for exacerbation of CD. She was treated with oral tacrolimus, prednisolone, methotrexate, and 6-mercaptopurine. Additionally, total parenteral nutrition was administered through a central venous catheter (CVC). After four months from the CVC was placed, she developed a fever of 39.3 C, hypotension (84/ 42 mmHg), sinus tachycardia (160 beats/min), and tachypnea (40 breaths/min) during hospitalization. Her general appearance was unwell without other remarkable findings. Laboratory data showed a leukocyte count of 4,700/mL (band neutrophils 13%, segmented neutrophils 70%, lymphocytes 12%, monocytes 4.5%, eosinophils 0.5%, and erythroblasts 1.0%), thrombocytopenia (platelet count 100,200/mL), and an increased C-reactive protein level (11.8 mg/dL). Vancomycin and meropenem were empirically administered for sepsis, including a catheter-related bloodstream infection (CRBSI), after two sets of blood cultures were obtained. The next morning, results of a peripheral blood smear (PBS) showed yeast cells phagocytized by leukocytes (Fig. 1). Therefore, micafungin was immediately administered, and the CVC was removed. The blood cultures grew Candida albicans after a two-day incubation, and a culture obtained from the CVC grew C. albicans. A diagnosis of CRBSI due to C. albicans was made. Subsequently, fluconazole was administered instead of micafungin because bilateral endophthalmitis was detected by an ophthalmologist. Fluconazole was continued for 12 weeks until complete resolution of endophthalmitis. She recovered without any visual disturbance.