Invasive Conidiobolus infection in an immunocompromised pediatric patient in Southern California

Background Conidiobolus species are largely known to cause rhinofacial cellulitis in healthy individuals but can manifest as an invasive infection in immunocompromised patients. Few cases have been described in the literature as they are difficult to diagnose and rarely observed in North America, particularly in the pediatric population. Case Summary A 15-year-old boy with a history of multiple bone marrow transplants for mixed phenotype acute leukemia presented to the emergency department with febrile neutropenia and chills. His clinical course was complicated by potential Rothia mucilaginosa bacteremia, but imaging revealed a potential invasive pulmonary fungal infection. Following rapid decompensation and admission in the intensive care unit, plasma cell-free DNA sequencing was ordered, identifying Conidiobolus species. The same organism was then isolated in the patient’s sputum culture shortly thereafter. This organism was found to demonstrate high minimum inhibitory concentration to antifungals tested in vitro . Ultimately, the patient was discharged on posaconazole and trimethoprim-sulfamethoxazole. Conclusion Conidiobolus can be an agent of invasive fungal infection and may be considered a potential infectious agent in the immunocompromised patient. Treatment and outcomes of invasive Conidiobolus remain elusive.