Recurrent Mucor indicus central venous catheter infection in a five year old child on long term parenteral nutrition for short gut syndrome: could gut translocation be responsible?

A five year old girl with life-long TPN dependence for short gut syndrome presented with two episodes of non-fatal Mucor indicus central line associated blood stream infection (CLABSI). Each episode occurred fifteen months apart, without any evidence of ongoing mould infection whilst off antifungal therapy in the intervening time period. Both episodes were treated with removal of the infected central venous catheter (CVC) and 6 weeks of intravenous liposomal amphotericin B and/or posaconazole, with good clinical, microbiological, and radiological response. The possibility of gut translocation is supported by the repeated isolation of Mucor indicus in cases of intestinal mucormycosis. To our knowledge, this is the first case of recurrent episodes of blood culture positive mucormycosis in a single patient. Mucor indicus blood stream infection may differ significantly from invasive mucormycosis caused by other species.