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Masquerading Yeast: A Case Report of Lomentospora prolificans Fungemia With a Diagnostic Twist

Summary

This case describes a patient with blood cancer who developed a rare and deadly mold infection called Lomentospora prolificans while receiving cancer treatment. The infection was difficult to diagnose initially because the fungal structures looked similar to yeast under the microscope, and a molecular test gave a false positive result for a different fungus. Unfortunately, the infection was resistant to all available antifungal medications and the patient died.

Background

Lomentospora prolificans is an environmental mold increasingly recognized as a highly virulent opportunistic pathogen in immunocompromised hosts. Disseminated mold infections are challenging to diagnose and distinguish from other fungal pathogens.

Objective

To present a case of disseminated Lomentospora prolificans infection in a patient with refractory acute myeloid leukemia and highlight diagnostic challenges and treatment limitations.

Results

Initial misidentification of Lomentospora conidia as yeast forms on gram stain and false-positive PCR result for Candida tropicalis delayed diagnosis. The isolate demonstrated resistance to all commercially available antifungal agents including amphotericin B, voriconazole, and terbinafine.

Conclusion

This case highlights diagnostic challenges in identifying disseminated mold infections, the importance of understanding fungal life cycles, and the need for improved diagnostics and novel antifungal treatments for Lomentospora prolificans.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 41103781, DOI: 10.1093/ofid/ofaf598
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