Fatal candida pneumonia in a non-immunosuppressed host

An 83-year-old previously well non-immunosuppressed woman developed invasive fatal candida pneumonia, apparently caused by aspiration. Diagnosis was suggested by the presence of sheets of budding yeasts and pseudohyphae on Gram-stained expectorated sputum and confirmed by an open lung biopsy which demonstrated candida invading lung tissue. Culture of material obtained by open lung biopsy yielded Candida albicans. At autopsy the patient had extensively invasive bilateral candida pneumonia. No other pathogens were isolated from sputum, open lung biopsy or at the time of autopsy. Evidence of disseminated candidiasis was not seen at autopsy. To our knowledge, this is only the fourth documented case of aspiration candida pneumonia in a non-immunosuppressed adult. While candida pneumonia in an immunocompetent adult is very rare, it should be considered in an elderly patient who is not responding to antibiotic therapy. Diagnosis requires aspiration or biopsy of lung, with preferably both histological and cultural evidence of candida infection.