Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with persistent fever, right upper quadrant (RUQ) abdominal pain, and malaise. History significant for immunocompromise (e.g., neutropenia, malignancy, or prolonged corticosteroid use). Reports associated symptoms of nausea, anorexia, and weight loss. No history of recent travel or biliary instrumentation.
Clinical Examination Findings
Physical exam reveals tenderness in the RUQ with possible hepatomegaly. Patient may exhibit jaundice or signs of systemic inflammatory response syndrome (SIRS). Auscultation of the abdomen shows diminished bowel sounds. Skin assessment for disseminated candidiasis (e.g., papular lesions) is negative/positive.
Treatment Protocol
Initiate systemic antifungal therapy with intravenous Echinocandin (e.g., Caspofungin) or Liposomal Amphotericin B. Consider transition to oral Fluconazole or Voriconazole based on susceptibility testing. Evaluate for percutaneous drainage if abscess is large or symptomatic. Monitor liver function tests (LFTs) and renal function closely throughout treatment.