Candida albicans induced acute chest syndrome in sickle cell disease

Abstract

To the Editor: Acute chest syndrome (ACS) is the leading cause of hospitalization and death among patients with sickle cell disease (SCD).1 The pathogenesis of ACS is multifactorial with infection being the most common cause in children.2 Fungal infections are uncommon in patients with SCD.3–7 We report a fatal case of ACS associated with Candida albicans infection in a pediatric patient with SCD. An 8-year-old known patient of homozygous SCD presented with 4 days of sore throat, body ache, and new-onset fever. His immunization was up to date, and his past history included well-controlled asthma and an admission for vaso-occlusive crisis (VOC). At presentation, his vital parameters were temperature: 38.5◦ Celsius, respiratory rate (RR): 26/min, pulse: 135/min, and oxygen saturation: 94%. He had tenderness in his lower extremities with sore calf muscles. His laboratory studies revealed white blood count: 20.3 × 103/μL with 82% neutrophils, hemoglobin (Hb): 8.6 g/dL; normal liver function; and serum chemistry with unremarkable chest X-ray. He was admitted for management of VOC, which was commenced using ceftriaxone, morphine, and nasal cannula oxygen. In the next 24 h, he developed new onset crackles in both axillae and his chest X-ray revealed bilateral lower lobe pulmonary infiltrates and small pleural effusions. A concern for ACS was raised and he received one unit of packed red cells transfusion (PRBCs), furosemide, and clarithromycin. He rapidly decompensatedandprogressed tobradycardic cardiorespiratory arrest requiring intubation, epinephrine, and brief chest compressions. He was treated with mechanical ventilation, inotrope support, two units of PRBCs transfusion, vancomycin, and commenced on two cycles of exchange transfusion. In the next 12 h, he progressed to multiorgan failure including acute hepatic failure, oligo-anuric renal failure, acute respiratory distress syndrome, and coagulopathy. He was placed on inhaled nitric oxide and continuous veno-venous hemodialysis. He developed