First Case of Candidemia With Fluconazole-Resistant Candida albicans and Y132H Mutations in ERG11 Gene From Pakistan.

Candida albicans is one of the critical priority fungal pathogens as classified by the World Health Organization. Fluconazole resistance in C. albicans is increasingly being reported from different parts of the world. The epidemiology of antifungal resistance in Pakistan is evolving. While fluconazole resistance is rarely reported in invasive candidemia, it has been identified in noninvasive Candida isolates. Here, we describe the first case of candidemia with fluconazole-resistant C. albicans with Y132H mutations in the ERG11 gene from Pakistan. A 36-year-old male patient with comorbid conditions, including diabetes mellitus, hypertension, and a recent history of critical COVID-19 pneumonia, presented to the hospital emergency department with septic shock secondary to Fournier's gangrene. Blood culture confirmed fluconazole-resistant C. albicans. Our case report underscores the urgent need for antifungal stewardship to prevent the escalating issue of antifungal resistance.