Asymptomatic Candiduria due to Candida inconspicua in a Patient With Hematologic Malignancy

Candida inconspicua is an uncommon opportunistic yeast, increasingly reported in immunocompromised patients. We describe a case of asymptomatic Candiduria caused by C. inconspicua in a 43-year-old woman with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia undergoing chemotherapy. During multiple episodes of high-risk febrile neutropenia, urine cultures repeatedly isolated C. inconspicua, identified via MALDI-TOF MS and exhibiting high fluconazole resistance (MIC: 16.0 μg/mL). Despite these findings, no antifungal therapy was administered due to the absence of urinary symptoms and resolution of fever with antibacterial treatment. This case illustrates the clinical dilemma posed by rare, drug-resistant Candida species in asymptomatic infections, emphasizing the importance of precise microbiological identification and antimicrobial stewardship. The emergence of C. inconspicua, with potential for resistance and biofilm formation, underscores the need for careful evaluation in hemato-oncological patients, particularly when considering the risks and benefits of initiating antifungal therapy in the absence of clinical symptoms.