Probable Nakaseomyces glabratus candidemia following ureteral lithotripsy in a patient with poorly controlled diabetes: a case report
Candidemia is a severe form of invasive candidiasis, and early etiological diagnosis may be difficult when blood cultures are negative or delayed. Nakaseomyces glabratus (formerly Candida glabrata) is clinically important because it is often less susceptible to azoles than Candida albicans, which can influence early antifungal selection. The present study reports the case of a 60-year-old woman with long-standing poorly controlled type 2 diabetes mellitus who developed persistent high fever, chills, nausea and vomiting after ureteral lithotripsy for a right ureteral stone. On admission, inflammatory markers were markedly elevated, and abdominal CT suggested a severe right-sided urinary tract infection (UTI) involving the kidney, ureter and bladder. Initial blood cultures remained negative within 48 h. As fever persisted despite empirical meropenem plus fluconazole therapy, blood mNGS was performed and identified N. glabratus. Treatment was subsequently escalated to a caspofungin-based regimen. Urine culture obtained afterward yielded 70,000 CFU/mL N. glabratus, although antifungal susceptibility testing was not performed. Fluconazole was continued for urinary tract coverage, after which the patient became afebrile and inflammatory markers normalized. This case suggests that blood mNGS may provide clinically useful species-level information when conventional blood cultures are non-diagnostic. However, since bloodstream infection was not culture-confirmed, the diagnosis should be classified as probable rather than definitive N. glabratus candidemia. The case also emphasizes that optimal management should include antifungal susceptibility testing whenever possible, repeat blood cultures to document clearance, source control and formal ophthalmological assessment.