Cokeromyces recurvatus in a cervical papanicolaou test: A case report of a rare fungus with a brief review of the literature.

Here we report a rare case of Cokeromyces recurvatus in a Pap test in an asymptomatic pregnant patient. Each liquid-based Pap slide contained multiple rounded yeast-like forms measuring 10-30 µm including some profiles with peripheral small buds. The background had neither epithelial abnormality nor any significant inflammation. A positive silver stain aided in confirming a fungal organism. Rare fungi were considered including Paracoccidioides brasiliensis due to the 'mariner's wheel' morphology of forms with peripheral budding; however, the final report morphologically favored C. recurvatus which was subsequently confirmed by culture. This is the sixth report of C. recurvatus isolated at a gynecologic site. While C. recurvatus has been reported to cause invasive disease in immunocompromised patients at deep sites, in the gynecologic tract it has so far been reported as a non-pathogenic colonizer. Awareness of this organism and use of either culture or molecular diagnostics are important in avoiding misdiagnosis.