Disseminated Candidiasis in MPO-Deficient Patients

Diagnostic Considerations

The Infectious Diseases Society of America recommends that an axial yeast skin rash in an MPO-deficient patient with C. glabrata vaginal colonization should raise significant concern for disseminated candidiasis and warrants aggressive diagnostic evaluation including skin biopsy with culture, blood cultures, and consideration of systemic antifungal therapy 1
Disseminated candidiasis presents with discrete pink to red papules or nodular lesions, typically on the trunk and extremities, with lesion evolution characterized by central pallor or hemorrhagic transformation if thrombocytopenia is present 1
The presence of high fever and poor general condition at onset is characteristic of systemic candidiasis 1

The Infectious Diseases Society of America recommends that echinocandins, such as caspofungin, micafungin, or anidulafungin, are preferred for invasive C. glabrata due to azole resistance 1, 5
Amphotericin B formulations remain effective alternatives for the treatment of invasive C. glabrata 1, 4, 5
Voriconazole or posaconazole may be considered but have variable efficacy against C. glabrata 1, 5

For C. glabrata vulvovaginal candidiasis without systemic involvement, topical boric acid 600 mg intravaginally daily for 14 days is preferred 6
Alternative treatments include 17% flucytosine cream alone or combined with 3% amphotericin B cream for 14 days 6

Skin biopsy with culture is essential for the diagnosis of disseminated candidiasis, and recovery of fungi from skin or soft tissue aspiration/biopsy almost always warrants aggressive systemic therapy 1, 4, 5
Blood cultures should be obtained immediately, although they may be negative in 50-75% of systemic candidiasis cases 1
Histopathology should look for yeasts, pseudohyphae, or true hyphae in tissue specimens, and clinical assessment priorities include evaluating for fever, myalgias, and signs of deep tissue involvement 1