Post-Surgical Abdominal Myonecrosis: The Unusual Role of Candida albicans

TL;DR

A 77-year-old woman developed a rare fungal infection of the abdominal muscles after surgery, caused by Candida albicans.

Contribution

This case highlights the rare but critical role of Candida albicans in causing post-surgical necrotizing myonecrosis.

Findings

Candida albicans was the sole causative agent in a case of post-surgical necrotizing myonecrosis.

The patient required antifungal therapy and multiple surgical debridements after initial antibiotic treatment.

The infection occurred following an iatrogenic injury to the small bowel during surgery.

Abstract

Necrotizing myonecrosis is a life-threatening infection of the skeletal muscle and soft tissues, predominantly caused by bacteria such as Staphylococcus aureus and Group A Streptococcus. In rare cases, fungal organisms, particularly Candida albicans, have been identified as the sole causative agent in these infections. We present a rare case of a 77-year-old female patient who underwent an elective hysterectomy that was complicated by an iatrogenic injury to her small bowel, which was missed in the preliminary surgery. Postoperatively, she developed signs of peritonitis and greenish-brown drainage from her incision site. Exploratory laparotomy confirmed small bowel perforation. Subsequently, she developed abdominal sepsis and necrotizing myonecrosis involving the anterior abdominal wall musculature. Empiric treatment with broad-spectrum antibiotics was initiated. Intraoperative cultures revealed isolated Candida albicans, prompting a shift in management to antifungal therapy and multiple surgical debridements of the anterior musculature.

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