Invasive fungal pericarditis caused by non-albicans species like Candida guilliermondii can serve as an initial clinical manifestation of an occult neoplasm, such as lung carcinoma.
Deep fungal infections, especially in sterile sites such as the pericardium, are rare clinical entities with high morbidity and mortality, often associated with severe immunosuppression. Among the most common pathogens are Candida spp., Aspergillus spp., and Mucor spp. Non-albicans species such as Candida guilliermondii have emerged as relevant opportunistic agents, frequently related to intrinsic antifungal resistance. A 42-year-old woman with history of pulmonary thromboembolism and bronchial asthma in April 2024 had been using chronic corticosteroids since then, without specialized follow-up. On 03/01/2025, she developed dry cough, progressive dyspnea, chest pain, and a single measured febrile episode (39°C). She was initially treated symptomatically with partial improvement, but subsequently developed lower-limb edema, about 9 kg weight gain over 10 days, and progressive dyspnea, leading to hospitalization on 03/20/2025. Imaging showed a large pericardial effusion, moderate bilateral pleural effusion, and findings suggestive of an associated infectious process. New pulmonary embolism was ruled out. Serologies and immunodeficiency workup (immunoglobulins, CD4/CD8 T cells, autoimmune panel) were within normal limits. Empiric broad-spectrum antibiotics were started, but the course was unfavorable. Diagnostic and therapeutic pericardiocentesis was performed in April 2025, yielding serous fluid whose culture isolated Candida guilliermondii as the only agent. On 04/29/2025, she was treated with lipid complex amphotericin B (total dose 8,200 mg) for 41 days with favorable clinical response. On 05/15/2025, pericardial biopsy showed nonspecific chronic pericarditis without malignancy and negative cultures. During hospitalization, she had thrombotic events and multiple episodes of cardiac tamponade. Imaging suggested an ill-defined mediastinal nodular lesion. In June 2025, primary lung carcinoma was confirmed by mediastinal biopsy. This case underscores the importance of recognizing invasive fungal infections by unusual non-albicans agents in sterile sites as potential clinical manifestations of occult neoplasms, even in the absence of evident laboratory immunosuppression.
Braga et al. (Sun,) studied this question.