Abstract
Magnusiomyces capitatus is a rare cause of fungal infection in immunocompromised patients, mainly seen in hematological malignancies. M capitatus infections are extremely rare in immunocompetent patients, as it is part of normal human microbial flora. We are presenting an extremely rare case of M capitatus peritonitis in an otherwise immunocompetent patient who suffered from gastrointestinal leakage due to pancreatitis. Fungal identification was performed at reference laboratory by phenotypic characteristics and DNA sequencing of target internal transcribed spacer region of the rRNA gene and the D1-D2 domain of the large-subunit rRNA gene and susceptibility testing by Clinical and Laboratory Standards Institute guidelines (document M27-S4) broth dilution method. He was successfully treated with a combination of surgical repair and voriconazole single therapy.
Highlights
M capitatus is extremely rare in immunocompetent patients, as it is part of normal human microbial flora.[18]
A 32-year-old alcoholic male with liver steatosis presented with hemorrhagic necrotizing pancreatitis with peritonitis and retroperitoneum involvement. He was started on conservative therapy and percutaneous irrigation and drainage. He rapidly deteriorated on hospital day 4 into acute abdominal compartment syndrome with acute respiratory distress
Peripancreatic necrosis was noted to extend proximally to diaphragm with extensive dissection throughout the retroperitoneum and at the root of the small bowel retroperitoneal area
Summary
Magnusiomyces capitatus, previously known as Geotrichum capitatum, Dipodascus capitatus, Trichosporon captiatum, Saprochaete capitata, or Blastoschizomyces capitatus,[1] is a rare cause of fungal infection in immunocompromised patients, mainly seen in hematological malignancies.[2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17] M capitatus is extremely rare in immunocompetent patients, as it is part of normal human microbial flora.[18]. There was suspicion of incomplete drainage of intraabdominal fluid, and so a retroperitoneal drain was placed by interventional radiology on hospital day 31 Culture of this retroperitoneal fluid grew vancomycin-resistant enterococci E faecium (VITEK2, bioMérieux) and M capitatus (identification by phenotypic characterization and DNA sequencing of targets internal transcribed spacer region of the rRNA gene and the D1-D2 domain of the large-subunit rRNA gene and the D1-D2 domain of the large-subunit rRNA gene by University of Texas Health Science, San Antonio, TX; see Figures 1-3). A 12-week course of voriconazole (minimum inhibitory concentration = 0.25 μg/mL by Clinical and Laboratory Standards Institute broth dilution M27-S4 method by the University of Texas Health Science, San Antonio, TX; see Table 1) was started on hospital day 45 Warfarin for his pulmonary embolism was switched to enoxaparin due to drug-drug interaction of warfarin with voriconazole.
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