Case Report: Rhodotorula mucilaginosa fungemia in a Tunisian child: a case report and narrative literature review

Introduction Rhodotorula mucilaginosa is an uncommon opportunistic yeast associated with bloodstream infections, particularly in patients with intravascular catheters or impaired host defenses. We report a pediatric case of fungemia and provide a narrative review of published cases. Case presentation An 11-year-old girl without documented immunodeficiency or immunosuppressive therapy was hospitalized for convulsive encephalopathy complicated by aspiration pneumonia. Following femoral venous catheterization and treatment for catheter-tip Candida albicans , she remained febrile despite antifungal therapy with fluconazole followed by caspofungin. On Day 24, a peripheral blood culture yielded abundant growth of a yeast producing mucoid coral-pink colonies. Identification of Rhodotorula mucilaginosa using the VITEK ® 2 Compact system was confirmed by internal transcribed spacer polymerase chain reaction followed by MspI restriction fragment length polymorphism analysis. Antifungal susceptibility testing using Etest ® , read after six days of incubation, showed a voriconazole minimum inhibitory concentration (MIC) of >32 mg/L and an amphotericin B MIC of 0.125 mg/L. Voriconazole was discontinued, and liposomal amphotericin B was initiated on Day 30. Fever resolved and inflammatory markers decreased markedly within two days. Treatment was continued for 15 days, and subsequent blood cultures remained negative. Conclusion This case highlights the importance of timely species-level identification and antifungal susceptibility testing when an unusual yeast is isolated from blood. Although species-specific clinical breakpoints are unavailable, the MIC profile, interpreted alongside the clinical course, supported the use of liposomal amphotericin B, which was followed by clinical improvement and sustained microbiological clearance.