Critical Care and Shock

Red blood cell fragmentation in acute respiratory distress syndrome following Candida dubliniensis pneumonia

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Background: The mechanisms underlying red blood cell fragmentation in intensive care patients remain controversial. Candida dubliniensis infection is very rarely reported in the world, and which has primarily been restricted to patients with a weak­ened immune system, and there is limited clinical information about the virulence of C. dubliniensis for hemolytic activity.

Case: A 79-year-old man, who had recovered from acute respiratory distress syndrome (ARDS), pre­sented with severe sepsis and was transferred to the emergency room. The ratio of arterial oxygen partial pressure to the fraction of inspired oxygenation (FiO2) (P/F ratio) in the arterial blood gas analysis was low (77%). Immediate treatment included in­tubation and antibiotic infusion. However, after 17 days, his general condition deteriorated suddenly, and red blood cell fragmentation was observed upon hematological examination. We treated him with an infusion of 4 units of packed red blood cells and 4000 units of haptoglobin. However, 3 days later, the patient died of multiple-organ failure and dissemi­nated intravascular coagulation. Throughout the treatment period, C. dubliniensis pneumonia was detected twice in the examination of his sputum.

Conclusion: To our knowledge, this is the first case report of red blood cell fragmentation in ARDS fol­lowing C. dubliniensis pneumonia in Japan.