A Unique Clinical Presentation of an Emerging Invasive Fungal Infection in a Hospitalized Patient: the Lessons Learned

Abstract

Invasive Saccharomyces cerevisiae infection is a rare and emerging fungal infection. The emergence of this invasive infection is due to the increased use of Saccharomyces boulardii probiotics. Saccharomyces boulardii probiotics are biotherapeutic agents used for the prevention and treatment of various diarrheal diseases. The benefits of these probiotics are well established; however, its associated infectious complications seem underestimated, especially in at-risk patients. Like other rare invasive yeast infections, invasive Saccharomyces infection has a high mortality rate. A 67-year-old man with multiple medical comorbidities and a complicated hospital course received Saccharomyces boulardii probiotics via percutaneous endoscopic gastrostomy tube for 22 days for Clostridium difficile prophylaxis treatment. We diagnosed him with invasive Saccharomyces cerevisiae fungemia resulting from Saccharomyces cerevisiae peritonitis. He developed multiple organ failure and shock, which led to his death 27 days after his first dose of Saccharomyces boulardii probiotics. To the best of our knowledge, we report the first case of invasive Saccharomyces cerevisiae fungemia due to Saccharomyces cerevisiae peritonitis caused by the combination of percutaneous endoscopic gastrostomy (PEG) tube placement and PEG tube administration of Saccharomyces boulardii probiotics in an at-risk hospitalized patient. Our goals for reporting this case are to heighten the index of clinical suspicion of invasive Saccharomyces fungemia, discuss the lessons we learned, and revisit the literature on the management of invasive Saccharomyces infection in at-risk hospitalized patients.