Refractory Candidozyma (Candida) auris-associated central nervous system infection in a postoperative neurosurgical patient.

Abstract

Background: Candidozyma (Candida) auris has emerged as a global health threat because of its ability to persist on skin and environmental surfaces and its frequent resistance to multiple antifungal agents. We describe a rare but clinically significant case of C. auris-associated central nervous system (CNS) infection in a postoperative neurosurgical patient.

Case summary: A 60-year-old woman developed a postoperative cerebrospinal fluid (CSF) leak following intradural lumbar tumor resection and was readmitted with headaches, neck pain, and nausea. CSF and wound cultures grew C. auris, while blood cultures remained negative, suggesting localized CNS involvement. Combination antifungal therapy with liposomal amphotericin B, flucytosine, and micafungin, later supplemented with posaconazole, was initiated but was complicated by significant toxicities requiring dose adjustments and stepwise discontinuation. Antifungal susceptibility testing demonstrated reduced susceptibility to amphotericin B, and C. auris was repeatedly isolated from CSF despite therapy. Given persistent recovery of the organism, the clinical team initiated the US Food and Drug Administration Single Patient IND process to obtain fosmanogepix, an investigational antifungal agent, although the request was ultimately discontinued as the patient clinically stabilized. She was discharged on long-term oral voriconazole for antifungal suppression because of persistent CSF isolation of C. auris, multidrug resistance, and limited CNS penetration of previously administered antifungals.

Conclusion: This case highlights diagnostic uncertainty, therapeutic challenges, and antifungal decision-making complexities following isolation of C. auris from CSF.