Surgical management of fungal peripheral thrombophlebitis.

Fungal infection of central venous catheters is well described. Peripheral fungal thrombophlebitis, however, has only been recognized recently, is thought rare, and is poorly characterized as to clinical presentation and treatment. We report the cases of eight patients with peripheral Candida thrombophlebitis. Patients were elderly and critically ill. All had received broad-spectrum antibiotics. Skin colonization appeared the source of contamination. Sepsis, shock, and organ failure were frequent. Physical findings of fungal phlebitis may be subtle, and diagnosis is often delayed. Multiple sites are frequently involved. Treatment necessitates radical excision of suspected veins and systemic antifungal chemotherapy. Persistent fungemia suggests inadequate phlebectomy or the existence of further affected veins. Peripheral thrombophlebitis is probably a common source of fungal sepsis and should be considered in all patients with fungemia. Without aggressive surgical intervention, survival is unlikely.