Fatal Invasive Candidiasis Diagnosed at Autopsy in a Long-term Hospitalized Patient: A Case Report

Abstract

Invasive candidiasis is a severe fungal infection caused by Candida species that typically affects immunocompromised individuals. However, emerging evidence shows that even previously immunocompetent patients can develop invasive candidiasis under conditions such as prolonged hospitalization, broad-spectrum antibiotic use, and post-sepsis immunosuppression. We report the case of a 62-year-old male who experienced severe but nonfatal head trauma and required long-term hospitalization for persistent delirium. During his stay, he experienced recurrent febrile episodes that responded poorly to empirical antibacterial treatment. He ultimately deteriorated and died from sepsis. Autopsy revealed disseminated invasive candidiasis with Candida myocarditis, bilateral pulmonary involvement, and renal pyelonephritis, which led to acute renal failure and Candida sepsis. Notably, no antifungal therapy was administered during hospitalization. This case highlights the diagnostic challenges of invasive candidiasis, particularly in patients without classical immunocompromised conditions and in the absence of positive blood cultures for fungal organisms. From a forensic perspective, this case highlights the importance of comprehensive histopathological evaluation of suspected sepsis- related deaths. We emphasize that both clinicians and forensic pathologists must be aware of the risk of fungal infections in long-term hospitalized patients, because prompt diagnosis and appropriate treatment are critical for preventing fatal outcomes.