Papiliotrema laurentii fungemia in a neutropenic patient with limited echinocandin susceptibility: a case report.

Papiliotrema laurentii is a rare yeast species and an uncommon cause of human infection, and optimal management strategies have not been established. We report a case of P. laurentii fungemia in a 77-year-old male farmer who developed febrile neutropenia during chemotherapy for pancreatic cancer. Blood cultures obtained on two separate occasions yielded yeast in one of four bottles; a single isolate was identified as P. laurentii by a reference mycology laboratory using ITS and D1/D2 rRNA gene sequencing. The minimum inhibitory concentration of micafungin (MIC) was ≥16 μg/mL. The patient was initially treated with micafungin, and a central venous catheter was removed because a catheter-related bloodstream infection (CRBSI) was considered. Antifungal therapy included micafungin during hospitalization, temporary transition to oral fluconazole at discharge, and empirical voriconazole during readmission. The patient became afebrile during a period in which neutrophil recovery, central venous catheter removal, and antifungal therapy overlapped, and follow-up blood cultures confirmed clearance of fungemia. This case highlights the potential value of a stepwise, multifaceted approach to P. laurentii fungemia, integrating antifungal therapy, catheter management, host immune recovery, and microbiological follow-up when the clinical significance of an elevated micafungin MIC is uncertain.