Diagnostic Challenges in Invasive Saprochaete capitata Infection: A Case Report.
Saprochaete capitata is a rare opportunistic yeast-like fungus increasingly recognized as a cause of invasive infections, predominantly in immunocompromised hosts. While most cases are reported in patients with hematological malignancies and neutropenia, infections in patients with chronic metabolic and renal disorders are uncommon and often underdiagnosed. Isolation of S. capitata from urine is particularly rare and poses diagnostic challenges in distinguishing colonization from invasive disease.
We report a fatal case of sepsis associated with Saprochaete capitata isolated from the urine of a 65-year-old male with type 2 diabetes mellitus, chronic kidney disease, and chronic lymphatic filariasis. The patient presented with fever, chills, tachycardia, cellulitis of the right lower limb, and features of systemic inflammatory response syndrome. Laboratory investigations revealed marked leukocytosis, elevated inflammatory markers, and acute-on-chronic renal failure. Despite clinical features of sepsis, repeated bacterial blood and urine cultures were sterile. Urine microscopy showed pyuria, and culture on CLED agar yielded dry, creamy-white, yeast-like colonies. A lactophenol cotton blue mount demonstrated hyaline septate hyphae with rectangular arthroconidia. The isolate was urease-negative and was definitively identified as Saprochaete capitata by MALDI-TOF mass spectrometry. Antifungal susceptibility testing revealed low minimum inhibitory concentrations (MICs) for voriconazole, itraconazole, and posaconazole, with elevated MICs for echinocandins, consistent with known resistance patterns. The patient was treated empirically with broad-spectrum antibacterial agents but did not receive early antifungal therapy. His clinical condition rapidly deteriorated, progressing to septic shock and multi-organ dysfunction syndrome, requiring intensive care support, mechanical ventilation, vasopressors, and hemodialysis. Despite maximal supportive care, the patient succumbed to his illness.
This case highlights the clinical significance of isolating Saprochaete capitata from urine in high-risk patients presenting with sepsis and negative bacterial cultures. It underscores the need for heightened clinical suspicion, prompt fungal identification using advanced diagnostic methods, and early initiation of appropriate antifungal therapy. Awareness of this rare but aggressive pathogen is crucial for improving outcomes in vulnerable patient populations.
We report a fatal case of sepsis associated with Saprochaete capitata isolated from the urine of a 65-year-old male with type 2 diabetes mellitus, chronic kidney disease, and chronic lymphatic filariasis. The patient presented with fever, chills, tachycardia, cellulitis of the right lower limb, and features of systemic inflammatory response syndrome. Laboratory investigations revealed marked leukocytosis, elevated inflammatory markers, and acute-on-chronic renal failure. Despite clinical features of sepsis, repeated bacterial blood and urine cultures were sterile. Urine microscopy showed pyuria, and culture on CLED agar yielded dry, creamy-white, yeast-like colonies. A lactophenol cotton blue mount demonstrated hyaline septate hyphae with rectangular arthroconidia. The isolate was urease-negative and was definitively identified as Saprochaete capitata by MALDI-TOF mass spectrometry. Antifungal susceptibility testing revealed low minimum inhibitory concentrations (MICs) for voriconazole, itraconazole, and posaconazole, with elevated MICs for echinocandins, consistent with known resistance patterns. The patient was treated empirically with broad-spectrum antibacterial agents but did not receive early antifungal therapy. His clinical condition rapidly deteriorated, progressing to septic shock and multi-organ dysfunction syndrome, requiring intensive care support, mechanical ventilation, vasopressors, and hemodialysis. Despite maximal supportive care, the patient succumbed to his illness.
This case highlights the clinical significance of isolating Saprochaete capitata from urine in high-risk patients presenting with sepsis and negative bacterial cultures. It underscores the need for heightened clinical suspicion, prompt fungal identification using advanced diagnostic methods, and early initiation of appropriate antifungal therapy. Awareness of this rare but aggressive pathogen is crucial for improving outcomes in vulnerable patient populations.