Management of Diabetic Ketoacidosis Complicated by Invasive Systemic Candidiasis in Type 1 Diabetic Patient: A Case Report

Abstract

Diabetic Ketoacidosis (DKA) is a severe metabolic complication commonly associated with Type 1 Diabetes Mellitus (T1DM), characterised by hyperglycaemia, metabolic acidosis and ketonaemia, leading to significant morbidity and mortality if not promptly treated. Invasive systemic fungal candidiasis, caused by Candida species, is a critical opportunistic infection that can complicate DKA. This case report discusses a patient with type 1 diabetes who developed DKA, which was subsequently complicated by invasive systemic fungal candidiasis and multiorgan dysfunction. A 19-year-old female patient presented with complaints of vomiting, dyspnoea on exertion, swelling of the vagina, and left hypochondriac pain for two days. The patient had T1DM for two years and had missed her insulin doses, after which she developed DKA along with a vaginal Bartholin’s cyst that tested positive for fungi. She went into sepsis and septic shock. Subsequently, this developed into Multiple Organ Dysfunction Syndrome (MODS) after initially presenting as a local illness and then spreading to systemic invasive fungal candidiasis. The patient ultimately succumbed to the illness following a protracted stay in the Intensive Care Unit (ICU), despite receiving larger doses of antibiotics and antifungals, undergoing tracheostomy and mechanical ventilation, and having returned of spontaneous circulation, repeated Cardiopulmonary Resuscitation (CPR) cycles, as well as support from inotropic agents and vasopressors. This case highlights the necessity of early diagnosis and intervention with prompt action to prevent delayed diagnosis and complications that may arise. Serum 1,3 Beta-D-Glucan was positive, while Galactomannan was negative. Blood cultures were positive for Klebsiella pneumoniae. A vaginal swab culture from the Bartholin cyst revealed Candida albicans with pseudohyphae and budding yeast cells.

Keywords

• 1
• 3 beta d-glucan
• bartholin cyst
• candida albicans
• galactomannan