Asymptomatic Candiduria due to Candida inconspicua in a Patient With Hematologic Malignancy

TL;DR

A rare yeast, Candida inconspicua, caused asymptomatic infection in a leukemia patient, highlighting challenges in treating drug-resistant fungi without clear symptoms.

Contribution

Presents a clinical case emphasizing the challenges of managing asymptomatic, drug-resistant Candida infections in immunocompromised patients.

Findings

C. inconspicua was identified as the cause of asymptomatic candiduria in a leukemia patient.

The isolate showed high fluconazole resistance (MIC: 16.0 μg/mL) but did not require antifungal treatment.

The case highlights the importance of precise identification and antimicrobial stewardship in managing rare fungal infections.

Abstract

Candida inconspicua is an uncommon opportunistic yeast, increasingly reported in immunocompromised patients. We describe a case of asymptomatic Candiduria caused by C. inconspicua in a 43‐year‐old woman with Philadelphia chromosome‐positive B‐cell acute lymphoblastic leukemia undergoing chemotherapy. During multiple episodes of high‐risk febrile neutropenia, urine cultures repeatedly isolated C. inconspicua, identified via MALDI‐TOF MS and exhibiting high fluconazole resistance (MIC: 16.0 μg/mL). Despite these findings, no antifungal therapy was administered due to the absence of urinary symptoms and resolution of fever with antibacterial treatment. This case illustrates the clinical dilemma posed by rare, drug‐resistant Candida species in asymptomatic infections, emphasizing the importance of precise microbiological identification and antimicrobial stewardship. The emergence of C. inconspicua, with potential for resistance and biofilm formation, underscores the need for careful evaluation in hemato‐oncological patients, particularly when considering the risks and benefits of initiating antifungal therapy in the absence of clinical symptoms.

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