Fatal Systemic Candidiasis Following Treatment of Addisonian Crisis in a Juvenile Diabetic

A seventeen-year-old boy with juvenile diabetes mellitus developed fatal Candida meningitis with almost uncontrollable convulsions, following successful treatment of acute adrenal insufficiency. Autopsy demonstrated Candida abscesses of brain, kidney and heart, adrenal atrophy with lymphocytic infiltration, lymphocytic infiltration of pancreas, chronic thyroiditis and generalized lymphoid hyperplasia. Although positive Candida cultures are difficult to interpret in a diabetic, culture of the urine is essential for diagnosis of renal candidiasis. Blood-borne infections with C. albicans appear to involve the urinary tract even when meningoen-cephalitis or other organ involvement has not yet occurred. In retrospect this diabetic young man was clearly predisposed to candidiasis, and tooth extractions, steroid replacement for Addison's disease and later use of broad-spectrum antibiotics all played a role.