Candida albicans as the Sole Organism Cultured from a Perirectal Abscess

Perirectal abscess is a common colorectal condition that may be present with or without a fistula. In most cases where a fistula coexists the organisms cultured are gut-derived organisms whereas skin-derived organisms are more common in patients without fistula formation. Candida albicans, despite being an microorganism often found in the gastrointestinal tract, has not previously been reported as an isolate from a perirectal abscess culture. Here we report the case of a patient taking cefazolin in whom a perirectal abscess was diagnosed via computed tomography and aspiration of which demonstrated growth of only C. albicans. Prior literature has demonstrated that the microorganisms cultured from patients with perirectal abscesses do not differ between patients in whom antimicrobials had been used previously and those who were antimicrobial-na？ve, suggesting that there is a possibility that C. albicans is the sole organism responsible for the perirectal abscess in our patient. The patient underwent surgical drainage and was discharged with fluconazole and piperacillin/tazobactam, which led to the satisfactory recovery of the patient. 1. Background Perirectal abscess is a common colorectal disorder, more common in men than women [1, 2], that often requires surgical treatment. Most perirectal abscesses are thought to result from infection that originates in the anal crypts before extending into the anal glands in the intersphincteric plane [3, 4]. Approximately 90% of perirectal abscesses originate as cryptoglandular infections [5], with 80 to 90% of patients also having an accompanying fistula [2, 6]. Clinically, perianal or perirectal pain is the most common presenting symptom in abscesses in this area [7]. In patients with a fistula, the abscesses are more likely to contain multiple different organisms whereas abscesses without fistula tend to have less variety of flora and are more likely to isolate only one organism [2]. This suggests that fistula formation allows for more bacterial inoculation of the abscess. Most aerobic and anaerobic organisms isolated from perirectal abscesses are of gastrointestinal tract and skin flora origin [8]. Skin-derived organisms like Staphylococcus aureus are significantly more common in patients without fistula formation [2, 9, 10]. The mechanism of abscess formation from these organisms is thought to be due to skin-derived bacteria blocking apocrine glands, which is supported by the finding that fistulas are less likely to be present with abscesses containing Staphylococc [9, 10]. The incidence of gut-derived