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Intracardiac mass complicating Malassezia furfur fungemia
K A Schleman1, G Tullis, R Blum
1Department of Cardiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA. tawnylion@po.net
Abstract:
Malassezia furfur is a lipophilic yeast known to colonize indwelling catheters. Although progression to vasculitis and sepsis has been described, it has rarely caused fungemia in adults receiving nutrition via an indwelling catheter. Difficulty in diagnosis occurs as M furfur does not grow on routine culture media unless it is supplemented with fatty acids. We present the first case of M furfur fungemia in an adult, complicated by a pedunculated septic thrombus arising from the superior vena cava and extending into the right atrium. Removal of the catheter, amphotericin-B therapy, and surgical debridement were required for cure.
Insights
Malassezia furfur fungemia is rare in adults with indwelling catheters. This case highlights diagnostic challenges and the need for fatty acid supplementation in cultures for this lipophilic yeast.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Malassezia furfur is a common commensal yeast that colonizes indwelling medical devices, particularly in patients receiving parenteral nutrition.
- While M. furfur can cause opportunistic infections, fungemia in adults associated with indwelling catheters is uncommon.
- Standard microbiological culture techniques may fail to detect M. furfur due to its lipophilic nature, requiring specific media supplementation.
Observation:
- A rare case of Malassezia furfur fungemia in an adult patient with an indwelling catheter is presented.
- The fungemia was complicated by a significant pedunculated septic thrombus originating in the superior vena cava and extending into the right atrium.
- Diagnosis was challenging due to the yeast's fastidious growth requirements.
Findings:
- Successful treatment required a multi-modal approach including removal of the indwelling catheter.
- Systemic antifungal therapy with amphotericin-B was crucial for eradicating the fungemia.
- Surgical intervention was necessary for debridement of the septic thrombus.
Implications:
- This case underscores the importance of considering M. furfur in the differential diagnosis of catheter-related bloodstream infections, especially in immunocompromised patients or those with specific risk factors.
- Highlights the need for enhanced diagnostic protocols, including lipid-enriched culture media, for accurate identification of M. furfur.
- Emphasizes the potential severity of M. furfur fungemia and the necessity of prompt, aggressive management involving catheter removal, antifungal treatment, and potentially surgical intervention.