title: Sporopachydermia cereana fungaemia in refractory leukaemia presenting as breakthrough infection during micafungin therapy.
abstract: The Sporopachydermia cereana species lives in decaying stems of cactus and is exceptionally rare as a human pathogen. A 57-year-old man with therapy-refractory acute promyelocytic leukaemia developed severe neutropaenia. After about 3 weeks of micafungin used as prophylaxis, he developed high fever, multiple pulmonary nodular infiltrates and a painful leg lesion. Blood culture yielded a yeast which was not identified by the Vitek 2 system. On ITS1-5.8S-ITS2 gene sequencing, the isolate was identified as S. cereana. Antifungal sensitivity by the Etest showed that the minimum inhibitory concentration for fluconazole was 0.75 μg/mL, and for anidulafungin, it was >32 μg/mL. He responded to liposomal amphotericin B but later died of Escherichia coli septicaemia. There were no cactus plants in the vicinity, suggesting that S. cereana might have alternative habitats.
authors.affiliation: Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong.
authors.forename: T S Y
authors.initials: TS
authors.lastname: Chan
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Hwang
authors.forename: K K
authors.initials: KK
authors.lastname: To
authors.forename: Y-L
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D054714:Echinocandins / Q000627:therapeutic use*; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis; D017809:Fatal Outcome; D016469:Fungemia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications*; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000175:diagnosis; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D013902:Radiography, Thoracic; D004718:Saccharomycetales / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D018805:Sepsis / Q000150:complications / Q000175:diagnosis; D017422:Sequence Analysis, DNA; D012867:Skin / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D004275:DNA, Ribosomal; D021903:DNA, Ribosomal Spacer; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin