A Case of Persistent Candida Keyfr Bloodstream Infection in a Lung Transplant Recipient

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Mycology

Background:

• Idiopathic pulmonary fibrosis necessitates lung transplantation, a complex procedure with potential post-operative complications.
• Fungal infections, particularly from donor-derived sources, represent a rare but severe threat in solid organ transplantation.
• Candida Kefyr (Kluyveromyces marxianus) bloodstream infection poses significant morbidity and mortality risks.

Purpose of the Study:

• To report a unique case of donor-derived Candida Kefyr bloodstream infection following lung transplantation.
• To highlight the diagnostic and therapeutic challenges associated with rare fungal infections in transplant recipients.
• To emphasize the importance of clinical vigilance and multidisciplinary management in post-transplant complications.

Main Methods:

• A 67-year-old female lung transplant recipient developed refractory septic shock.
• Blood cultures identified Candida Kefyr, matching donor bronchoalveolar lavage isolates.
• Treatment involved escalating antifungal therapy (micafungin, posaconazole, liposomal amphotericin B, voriconazole) and supportive care, including extracorporeal membrane oxygenation (ECMO).

Main Results:

• Initial antifungal therapy failed to clear fungemia, requiring dose adjustments and addition of liposomal amphotericin B.
• Hemodynamic improvement and ECMO weaning were achieved after adding amphotericin B.
• Despite initial response, persistent candidemia and complications like effusions and chorioretinal lesions necessitated further treatment with voriconazole for ocular penetration.
• Successful clearance of fungemia and resolution of chorioretinal lesions were observed with prolonged antifungal therapy.

Conclusions:

• Donor-derived fungal infections are a rare but critical complication in lung transplantation.
• Candida Kefyr bloodstream infection, as presented, requires aggressive and tailored antifungal strategies.
• Heightened clinical suspicion, rapid diagnosis, and prompt, multidisciplinary intervention are essential for managing such rare post-transplant fungal infections.