Introduction: Opportunistic fungal infections are increasingly recognized in the ICU, but Saprochaete capitata remains rare, typically affecting profoundly immunocompromised patients. Invasive infections in those without classic risk factors such as neutropenia or chemotherapy are uncommon. We present a unique, fatal case of S. capitata pneumonia in an elderly ICU patient without traditional risk factors, highlighting diagnostic and management challenges in severe ARDS. Description: An 81-year-old male with asthma, idiopathic pulmonary fibrosis, coronary artery disease, and chronic hypoxic respiratory failure on home oxygen presented with worsening dyspnea. Imaging revealed subsegmental pulmonary emboli, and anticoagulation was initiated. Shortly after admission, he experienced a pulseless electrical activity arrest requiring intubation and vasopressors. He progressed to severe ARDS, necessitating prone positioning and maximal ventilatory support. Despite broad-spectrum antibiotics, he developed persistent fevers, worsening hypoxemia, and bloody pulmonary secretions. Bronchoscopy with lavage grew Saprochaete capitata and multidrug-resistant Klebsiella pneumoniae. Liposomal amphotericin B was started. Despite aggressive ICU care including antimicrobial optimization and hemodynamic support his condition deteriorated. After family discussion, care was withdrawn due to poor prognosis. Discussion: This case illustrates a rare but severe fungal infection in a patient without classic immunosuppressive risk factors. It raises the possibility that chronic lung disease and prolonged ICU exposure may predispose patients to uncommon pathogens. Early bronchoscopy and fungal cultures should be considered in unexplained pulmonary decline, especially when standard treatments fail. Co-infection with MDR organisms further complicates care, limiting therapy and worsening outcomes. Mortality from S. capitata remains high, underscoring the need for awareness, early diagnostics, and targeted management strategies in the ICU.
Chaney et al. (Sun,) studied this question.