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Severe Saprochaete capitata fungemia presenting as micafungin breakthrough hepatosplenic lesions in an immunocompromised patient: case report

Summary

A 70-year-old woman with blood cancer developed a serious fungal blood infection caused by Saprochaete capitata, a rare soil fungus, despite taking preventive antifungal medication. The infection spread to her liver and spleen, creating multiple lesions and a dangerous aneurysm. Doctors successfully treated her with a combination of three antifungal drugs, particularly voriconazole, which proved more effective than the initial preventive medication. This case highlights how rare fungi can cause severe infections in cancer patients and the importance of recognizing when standard preventive treatments are not working.

Background

Saprochaete capitata is a rare yeast-like fungus found in soil that can cause severe disseminated infections in immunocompromised hosts, particularly those with hematologic malignancies. Despite antifungal prophylaxis, this organism may cause breakthrough fungal infections with high morbidity and mortality. Management is complicated by lack of established antimicrobial susceptibility breakpoints and suspected echinocandin resistance.

Objective

This case report describes the clinical presentation and management of a severe S. capitata fungemia in a neutropenic patient with myelodysplastic syndrome who developed hepatosplenic involvement despite micafungin prophylaxis.

Results

A 70-year-old female developed high-grade S. capitata fungemia with hepatosplenic lesions while on micafungin prophylaxis. The organism showed elevated MICs for echinocandins but susceptibility to voriconazole and amphotericin B. The patient was successfully treated with combination therapy of voriconazole, liposomal amphotericin B, and flucytosine, followed by voriconazole monotherapy.

Conclusion

S. capitata can cause severe disseminated infection in patients with hematologic malignancy with apparent echinocandin resistance. Expert opinion recommends voriconazole as empiric treatment with the addition of intravenous liposomal amphotericin B for severe infections, though optimal treatment protocols remain unclear due to limited evidence.
  • Published in:ASM Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 41244286
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