Central venous catheter infection withRhodotorula minutain a patient with AIDS taking suppressive doses of fluconazole

Abstract

A case of Rhodotorula minuta central venous catheter infection with fungaemia is described in a patient with advanced acquired immunodeficiency syndrome (AIDS), HIV nephropathy, end-stage renal disease requiring haemodialysis, and a permanent Quinton catheter in place for 6 months. At the time of fungaemia, the patient was taking 100 mg fluconazole per os daily for a previous episode of Candida oesophagitis. R. minuta central venous catheter infection with fungaemia was successfully treated with 455 mg total dose amphotericin B (0.6 mg kg-1 day-1) over 25 days without removal of the catheter. In vitro antifungal susceptibility testing for R. minuta revealed a minimum inhibitory concentration to fluconazole of > 100 micrograms ml-1 and to amphotericin B of 1.2 microgram ml-1. Clinically evident fungaemia, even with an unusual organism such as R. minuta, may occur in patients with intravenous catheters, and while the immunosuppressed patient is receiving azole therapy.