Thread by @guerreroespejo

34-YO👨‍🦰congenital, idiopathic intestinal pseudo-obstruction, total parenteral nutrition & infusion of lipid emulsions: fever & cough (paroxysmal coughing with his port infusion)

CXR: interstitial infiltrates & areas of faint alveolar opacities
Portacath blood
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#microbiology

Smear: globose, oval, budding #yeast with a small collarette, suggesting Malassezia spp.
Olive oil–supplemented🧫: Malassezia sympodialis (identified by DNA sequencing)

FUNGEMIA INFECTION & LUNG EMBOLI BY MALASSEZIA SYMPODIALIS IN THE PORTACATH VENOUS ACCESS SYSTEM
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#MedEd

The portacath was removed, & the patient was given liposomal amphotericin B, for 4 weeks.

His symptoms were gone by week 2, and the interstitial infiltrates were nearly resolved by week 4.
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doi.org/10.1093/cid/ci…
#mycology #IDtwitter #MedTwitter

Systemic infections are uncommon.
The first case of a Malassezia spp catheter-related infection in the bloodstream reported (1981): in a premature infant receiving total parenteral nutrition with lipids with diffuse, bilateral lung infiltrates
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DOI: 10.1056/NEJM198112033052307

Malassezia infection in the bloodstream can be associated with lipid infusions & diffuse pulmonary infiltrates
If Malassezia infection is suspected, the microbiology laboratory should be notified to add specific lipids (ie, olive oil) to the culture media.
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#MedStudentTwitter

Treatment usually requires removal of the catheter and, if a systemic infection is suspected, antifungal therapy.
Most patients have been treated with amphotericin B preparations.
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#resident #medicine

Malassezia are part of the normal human cutaneous flora, & are associated with cutaneous rashes, such as:
✔️pityriasis versicolor,
✔️seborrheic dermatitis, and
✔️folliculitis .
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doi.org/10.1093/cid/ci…
#MedicalStudents #microbiology