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Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E. and Tomlanovich, M. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. The New England Journal of Medicine, 345, 1368-1377. doi:10.1056/NEJMoa010307

has been cited by the following article:

• TITLE: Fatal septic shock caused by candida myocarditis associated with malignant lymphoma and Epstein-Barr virus mediated disorder

  AUTHORS: Salah A. M. Said, Bart J. F. Liebrand, Nersing Bansraj, Erik Eijken

  KEYWORDS: Septic Shock; Candida Myocarditis; Epstein-Barr Virus Mediated Lymphoproliferative Disorder; Malignant Lymphoma; Arrhythmia

  JOURNAL NAME: Open Journal of Internal Medicine, Vol.1 No.2, September 30, 2011

  ABSTRACT: A 60-year-old man with known epilepsy was admitted to our hospital due to hypotension, fever and arrhythmia. He was treated medically and myocardial infarction was ruled out. Treatment of septic shock was established according to the guidelines of the early goal-guided therapy including vasopressors, inotropic agents, mechanical ventilation, and hemofiltration in combination with empirical treatment with antimicrobial drugs and hydrocortisone. The patient’s condition deteriorated rapidly into multiorgan failure resulting in a fatal outcome. Antemortem blood cultures were sterile. Autopsy findings were compatible with Epstein-Barr virus mediated lymphoproliferative disorder, malignant lymphoma, disseminated candidiasis and candida myocarditis. Post-mortem blood and tissue cultures were positive for growth of candida glabrata and candida albicans, respectively. The post-mortem examination documented Epstein-Barr virus mediated lymphoproliferative disorder and malignant small cell lymphoma associated with candida myocarditis. Prior to death, the patient did not receive antiviral or antifungal treatment. Fatal candida myocarditis associated with septic shock secondary to disseminated candidiasis in a 60-years old male patient with prior unknown immune compromised state caused by Epstein-Barr virus mediated lymphoproliferative disorder and malignant lymphoma is described.