Purpureocillium lilacinum Fungemia Masquerading as an Unidentified Yeast in a Heavily Immunosuppressed Patient With Relapsed Multiple Myeloma and Therapy-Related Mixed-Phenotype Acute Leukemia: A Case Report

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Publication Details

Journal
Cureus
Published
2026-09-17
DOI
https://doi.org/10.7759/cureus.116409
Primary Topic
Cancer Research and Treatments
Type
article
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article

Purpureocillium lilacinum Fungemia Masquerading as an Unidentified Yeast in a Heavily Immunosuppressed Patient With Relapsed Multiple Myeloma and Therapy-Related Mixed-Phenotype Acute Leukemia: A Case Report

Mostafa M. Abouzahra, Enas Abdallah, John Greene, Carolyn K Lackore et al.
Cureus
Cancer Research and Treatments
article

Purpureocillium lilacinum Fungemia Masquerading as an Unidentified Yeast in a Heavily Immunosuppressed Patient With Relapsed Multiple Myeloma and Therapy-Related Mixed-Phenotype Acute Leukemia: A Case Report

Mostafa M. Abouzahra, Enas Abdallah, John Greene, Carolyn K Lackore, Namisha Kathuria
article en

Abstract

Purpureocillium lilacinum (formerly Paecilomyces lilacinus) is an environmental saprophytic mold and an increasingly recognized opportunistic pathogen in immunocompromised hosts, most often causing cutaneous, ocular, or sinopulmonary disease; bloodstream infection (fungemia) is rare.The initial microscopic morphology on Gram stain of a positive blood culture can simulate yeast, delaying correct identification and appropriate antifungal therapy.We describe a 67-year-old man with relapsed multiple myeloma and therapy-related mixed-phenotype acute leukemia, further complicated by a prior Mycobacterium abscessus vertebral epidural abscess, who was admitted with neutropenic fever, hypoxic Burkholderia cenocepacia pneumonia, and multiorgan dysfunction.Blood culture demonstrated a yeast-like organism that could not be identified as any common Candida species by rapid multiplex polymerase chain reaction (PCR).The patient was later found to have portassociated Paecilomyces/Purpureocillium fungemia, with only one day of documented fungemia.The port was removed, and repeat blood cultures were negative.The isolate was submitted to a reference mycology laboratory and was identified as P. lilacinum approximately two weeks after the index blood culture.Susceptibility testing reported resistance to amphotericin B and a high minimum inhibitory concentration (MIC) to itraconazole, with lower MICs to posaconazole and voriconazole.He received posaconazole and liposomal amphotericin B briefly, followed by voriconazole, with clinical improvement and no recurrent fungemia.This case illustrates a clinically important diagnostic pitfall: rare filamentous molds such as P. lilacinum can mimic yeast morphologically and evade rapid yeast-identification panels, leading to delayed diagnosis in critically ill, heavily immunosuppressed patients.Early involvement of a reference mycology laboratory with molecular sequencing capabilities, when phenotypic identification is inconclusive, is warranted.The possibility of an amphotericin B-resistant mold simulating "yeast" fungemia should be considered in highrisk hematology-oncology patients.

Cureus
Al-Azhar University (EG), Moffitt Cancer Center (US), Government Medical College and Hospital (IN), Government Medical College and Hospital (IN), Al-Azhar University (ID)
Zero hunger
Openalex Percentile: Top 16%
Cancer Research and Treatments
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