When Fungal Prophylaxis Fails: A Rare Case of Rhodotorula mucilaginosa Fungemia with Suspected Abdominal Origin

We report a rare case of <i>Rhodotorula mucilaginosa</i> fungemia with a suspected abdominal origin in a 73-year-old man with advanced haematological disease on fluconazole prophylaxis. The patient presented with febrile neutropenia caused by a jejunal microperforation. Despite broad-spectrum antibiotics, the fever persisted, and <i>Rhodotorula mucilaginosa</i> was isolated from blood cultures. High-dose liposomal amphotericin B achieved microbiological clearance and clinical improvement. The case was further complicated by coinfection with <i>Aspergillus fumigatus</i> and <i>Klebsiella oxytoca</i>. To our knowledge, this is one of the few reported cases of abdominal <i>Rhodotorula</i> fungemia, and the first described in the context of fluconazole prophylaxis. This report emphasises the importance of recognising <i>Rhodotorula</i> as a true pathogen and highlights the challenges of managing rare fungal infections in immunocompromised hosts.