When Fungal Prophylaxis Fails: A Rare Case of Rhodotorula mucilaginosa Fungemia with Suspected Abdominal Origin

We report a rare case of Rhodotorula mucilaginosa fungemia with a suspected abdominal origin in a 73-year-old man with advanced haematological disease on fluconazole prophylaxis. The patient presented with febrile neutropenia caused by a jejunal microperforation. Despite broad-spectrum antibiotics, the fever persisted, and Rhodotorula mucilaginosa was isolated from blood cultures. High-dose liposomal amphotericin B achieved microbiological clearance and clinical improvement. The case was further complicated by coinfection with Aspergillus fumigatus and Klebsiella oxytoca. To our knowledge, this is one of the few reported cases of abdominal Rhodotorula fungemia, and the first described in the context of fluconazole prophylaxis. This report emphasises the importance of recognising Rhodotorula as a true pathogen and highlights the challenges of managing rare fungal infections in immunocompromised hosts.