Invasive Curvularia hawaiiensis infection with pleuropericardial involvement

We report a 31-year-old woman with cirrhosis who developed bilateral pleural and pericardial effusions caused by Curvularia hawaiiensis. The patient developed worsening shock and multiorgan failure during hospitalization despite broad-spectrum antibacterial and antifungal therapy. Her course was complicated further by development of bilateral pleural effusions and pericardial effusion. Pericardiocentesis and thoracentesis were performed, with cultures initially demonstrating scant mold growth. Liposomal amphotericin B was subsequently initiated; however, the patient ultimately died following transition to comfort-focused care. Postmortem identification of both pleural and pericardial isolates revealed Curvularia hawaiiensis, a rare dematiaceous mold infrequently associated with invasive disease. This case highlights the profound immune dysfunction associated with acute-on-chronic liver failure and demonstrates the potential for rare molds to cause rapidly progressive invasive infection in cirrhotic patients. Additionally, it underscores the diagnostic and therapeutic challenges posed by delayed organism identification and limited susceptibility data for uncommon fungal pathogens. This is the first reported pericardial infection due to this human pathogen.