Severe Saprochaete capitata fungemia presenting as micafungin breakthrough hepatosplenic lesions in an immunocompromised patient: case report

Background Saprochaete capitata ( S. capitata , also known as Magnusiomyces capitatus ), a yeast-like fungus commonly isolated from soil, is an emerging infection capable of disseminated infection in immunocompromised hosts, including those with hematologic malignancy. Case Summary A 70-year-old female admitted for induction therapy for myelodysplastic syndrome (MDS) developed persistent neutropenic fever while on antibacterial and micafungin prophylaxis. Blood cultures revealed high-grade S. capitata fungemia with imaging findings of hepatosplenic involvement in the setting of a central venous catheter and interatrial shunt. The patient was successfully treated with a combination of voriconazole, amphotericin B 3 mg/kg daily, and flucytosine. She was transitioned to voriconazole monotherapy after blood culture clearance and resolution of fever. Conclusion S. capitata may be associated with severe, disseminated infection in patients with hematologic malignancy. While there is a lack of evidence to guide optimal treatment, the organism appears to exhibit resistance to echinocandins. Expert opinion favors voriconazole as empiric treatment with the addition of intravenous liposomal amphotericin B for severe infections.