A 17-year-old male with short gut syndrome secondary to Hirschprung disease presented with a 2-week history of night sweats. He had an indwelling central line for total parental nutrition (TPN) supplementation and a history of multiple line infections with a variety of organisms. After completing a 10-day course of prophylactic fluconazole, and 1 week before the onset of night sweats, he had 4 teeth extracted.
Complete blood count showed a leukocyte count of 4.0 × 103/mL (73% neutrophils) and the peripheral blood smear revealed neutrophils with brilliant blue–colored yeast-like intraleukocytic organisms, 2 to 4 μm in diameter (see figure, Wright-Giemsa). The organisms had neither the pseudocapsule or eccentric chromatin suggestive of Histoplasma capsulatum; nor did they produce the “collarettes” indicative of the phialides of Malassezia furfur, a lipid-dependent yeast associated with fungemia in patients requiring TPN. Subsequently, blood cultures grew Candida glabrata. The isolate had a minimum inhibitory concentration of 16 μg/mL to fluconazole and 0.015 μg/mL to micafungin. Anidulafungin therapy was initiated and the infection cleared.
Candida glabrata is a commensal yeast of the gastrointestinal tract and mucocutaneous membranes of humans. It may cause bloodstream infections, especially in immunocompromised individuals or in those with indwelling lines.
