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Open Access Case report

Fungemia due to Lachancea fermentati: a case report

Anne-Marie Leuck*, Meghan K Rothenberger and Jaime S Green

Author Affiliations

Department of Medicine, University of Minnesota, D-416 Mayo Building, MMC 250, 420 Delaware St. SE, Minneapolis, MN 55455, USA

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BMC Infectious Diseases 2014, 14:250  doi:10.1186/1471-2334-14-250

Published: 10 May 2014

Abstract

Background

Lachancea fermentati is an environmental yeast that is also used in the fermentation of alcoholic drinks. It has not previously been described as a human pathogen although the closely related yeast, Saccharomyces boulardii, can cause fungemia. Here we report a case of L. fermentati acting as a pathogen in a septic patient with cultures positive from blood, peritoneal fluid, bile, and sputum.

Case presentation

A 36 year-old Caucasian man was hospitalized with acute alcoholic hepatitis complicated by Escherichia coli spontaneous bacterial peritonitis. Three days after admission, he developed new fevers with sepsis requiring mechanical ventilation and vasopressor support. He was found to have a bowel perforation. Cultures from blood, peritoneal fluid, and sputum grew a difficult-to-identify yeast. Micafungin was started empirically. On hospital day 43 the yeast was identified as L. fermentati with low minimum inhibitory concentrations (by Epsilometer test) to all antifungals tested. Micafungin was changed to fluconazole to complete a 3-month course of therapy. Serial peritoneal fluid cultures remained positive for 31 days. One year after his initial hospitalization the patient had ongoing cirrhosis but had recovered from fungemia.

Conclusion

This case demonstrates the need for clinicians to consider host factors when interpreting culture results with normally non-pathogenic organisms. In this immunocompromised host L. fermentati caused disseminated disease. We believe his hobby of brewing alcohol led to colonization with L. fermentati, which then resulted in invasive disease when the opportunity arose.

Keywords:
Lachancea fermentati; Fungemia; Opportunistic pathogen