Presentation

 
A 47-year-old female with a past medical history significant for end-stage renal disease, hypertension, hypothyroidism and deceased donor kidney transplantation. The patient now has chronic kidney disease of the transplanted kidney and is currently on immunosuppression therapy. The patient presented to an outside hospital with dyspnea and was found to be pancytopenic with a bone biopsy showing granulomatous inflammation with disseminated Mycobacterium avium complex. She was also found to have worsening renal failure and was intubated for acute hypoxic respiratory failure and transferred to UVA Health. Upon admission to the medical intensive care unit, the patient was initiated on continuous renal replacement therapy. Eight days into admission, the patient experienced bradycardia, hypotension and hypoxia with an irregular breathing pattern. She also required multiple infectious work-ups due to continuous fevers despite current therapies. Urine and blood cultures were collected and sent to the lab. A CT of the abdomen and pelvis showed perinephric stranding and edema of the transplanted kidney concerning for pyelonephritis. Both the urine and blood culture gram stains showed yeast. Cultures showing yeast were subcultured to Sabouraud agar (SAB) and CHROMagar and placed in the 35-degree Celsius hot air incubator. Plates showed smooth white colonies on the SAB. The CHROMagar had small white colonies with teal bullseyes that fluoresced under UV after about 48 hours.

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Author Information

Morgan Waddell, B.S., MLS(ASCP)CM, Infection Preventionist, University of Virginia Health.

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