Emerging Fungal Pathogen Causing a Persistent Rash

Candida haemulonii is a rare, fungal organism. This emerging, multidrug resistant pathogen can cause many different types of infections. We present a case of a previously healthy, 16-year-old girl with a lower extremity rash. The rash persisted despite treatment with a variety of oral and topical antifungal medications. It eventually resolved after treatment with intravenous echinocandins, a class of antifungal drugs that target the fungal cell wall. This case emphasizes the importance of forming a broad differential diagnosis. When a skin lesion does not respond to empiric treatment based on the presumptive diagnosis, one must consider atypical presentations and rare causes. C haemulonii , in particular, can be easily misidentified as other fungal pathogens. Therefore, genetic identification and antimicrobial susceptibility tests may be crucial in guiding diagnosis and treatment.