When a White Count is Needed the Most: The First Case Report of A
Neutropenic Patient Surviving Sporopachydermia cereana fungemia
Authors: Doris Hansen MD, Carter Milner MD, Adelor Zamora MD, Svenja Albrecht
MD, Risa Webb MD, Tondre Buck MD and Vincent Herrin MD
Author Affiliations: University of Mississippi Medical Center
Introduction
Sporopachydermia cereana is a cactophilic yeast first identified in 1978.
Only three other cases of S. cereana have been reported. It is exceptionally rare as a
human pathogen and has proved fatal in the other neutropenic patients.
Here, we report the first surviving patient with S. cereana fungemia per literature
review.
Case Report
A 58 year old African American woman with acute myeloid leukemia underwent
successful re-induction chemotherapy with cytarabine, etoposide, vincristine, and
daunorubicin immediately after failing the SWOG 1203 protocol of idarubicin,
cytarabine, and vorinostat.
Following her second induction, she became profoundly pancytopenic and remained
febrile despite broad spectrum antimicrobials, including thirty days of micafungin.
Chest X-ray indicated significant bilateral infiltrates and four consecutive blood
cultures demonstrated an unidentifiable Candida species. Micafungin was
discontinued and liposomal amphotericin B initiated.
Patient developed renal failure likely secondary to amphotericin B and respiratory
failure from volume overload requiring intubation. Pulmonary infiltrates resolved
with volume removal by continuous renal replacement therapy. Posaconazole and
caspofungin replaced amphotericin for broad coverage of both yeast and mold
infections. The candida isolate was identified by a reference laboratory as, the
cactophilic yeast, Sporopachydermia cereana. The patient denied having any
previous or recent exposure to cactus, and physical exam was unremarkable for any
skin lesions.
While intubated with respiratory failure, patient’s white blood cell count climbed in
a timely manner, likely contributing to the resolution of her infection. Repeat
cultures demonstrated no growth and the patient’s fevers resolved. Other diagnostic
studies obtained, including a transthoracic echocardiogram, dilated eye exam, and
CT chest, all revealed no evidence of metastatic infection.
Clinically, patient continued to improve after 20 days of total treatment with
caspofungin and posaconazole and remained without evidence of fungemia or
residual leukemia. She did remain on hemodialysis without return of her renal
function.
Discussion
Sporopachydermia cereana is an opportunistic cactophilic yeast which has occured
in the setting of refractory hematologic malignancy and persistent neutropenia but
previously resulted in death.
S. cereana is notoriously difficult to detect using conventional mycological
identification techniques. Future work is needed to identify alternative hosts and/or
environmental sources for S. cereana and to establish optimal treatment and
antibiotic duration.
As far as we are aware, this patient represents the first literature report of patient
survival after S. cereana infection acquired during recovery from induction
chemotherapy.
References:
Chan, T et al. Sporophacydermia cereana fungaemia in refractory leukemia
presenting as breakthrough infection during Micafungin therapy. Journal of
Infection, Volume 41, Issue 3, June 2013, pages 715 -717.
Parameswaran, A et al, First report of fatal human infections with the cactophilic
yeast Sporopachydermia cereana. Journal of infection. Volume 62, Issue 4, April
2011, pages 311 -313