Catheter-related Bloodstream Infection by <i>Yarrowia lipolytica </i>

Abstract

A 73-year-old Japanese man was admitted with edema of the limbs for 3 days. He was diagnosed with complete atrioventricular block. He underwent permanent pacemaker implantation and had a central venous catheter inserted into the right internal jugular vein. On day 8 of hospitalization, he had fever and his catheter was pulled out. The blood and catheter cultures were examined. On day 10, his blood culture yielded Candida sp. and liposomal amphotericin B was initiated. On day 12, the catheter tip culture was positive for Candida sp. Because of anemia, lower gastrointestinal endoscopy was performed, which revealed rectal cancer. On day 21, the permanent pacemaker was changed to a temporary pacemaker. Fluconazole was added to liposomal amphotericin B. On days 38 and 41, blood cultures remained positive for Candida sp.,which was identified as Yarrowia lipolytica using a polymerase chain reaction assay. Transesophageal echocardiography was performed, but vegetation was not observed. On day 52, he died. Y. lipolytica colonizes the human skin and feces and is poorly pathogenic. In recent years, case reports of immunocompromised and critically ill patients have increased, and catheter-related bloodstream infections have been particularly reported. Appropriate management of Y. lipolytica fungemia is controversial. Some patients with catheterrelated bloodstream infections by Y. lipolytica have been treated only with catheter removal without systemic antifungal therapy, but many patients have been treated with amphotericin B, fluconazole, or echinocandins.