Korean J healthc assoc Infect Control Prev.  2023 Jun;28(1):161-171. 10.14192/kjicp.2023.28.1.167.

Infection of the Cavernous Sinus Caused by Candida auris

• Lee SH
• Park SY
• Lee JS
• Oh J

• KMID: 2543147
• DOI: http://doi.org/10.14192/kjicp.2023.28.1.167

Abstract

Candida auris (C. auris) is a pathogen that causes severe infections, particularly in healthcare settings, and is resistant to common antifungal agents, leading to a global public health threat. Infections of the cavernous sinus are rare but potentially fatal. We report a rare case of cavernous sinus infection caused by drug-resistant C. auris. A 60-year-old woman with chronic otitis media underwent a mastoidectomy and tympanoplasty. The patient developed a surgical site infection with methicillin-resistant Staphylococcus aureus after the surgery, which improved with antibiotic treatment. However, she developed purulent otorrhea, ear pain, and a limitation of eye movement. Cultures of ear discharge repeatedly identified C. auris, and brain magnetic resonance imaging (MRI) findings were consistent with the presence of cavernous sinus infection and pachymeningitis. Therefore, amphotericin B and micafungin combination therapy was initiated for the C. auris infection. The patient showed no clinical improvement despite combination therapy with amphotericin B and micafungin; therefore, flucytosine was added to the treatment regimen. Symptoms improved after the triple-agent combination therapy, and a follow-up MRI showed improvement in the cavernous sinus infection and pachymeningitis.

Keyword

Antifungal combination therapy; Candida auris; Cavernous sinus infection; Otitis media