The case patient is an immunocompromised male in his 50s, who presents with fatigue, weakness, failure to thrive, low back and right leg pain, with a rash on the thigh and lower abdomen and altered mental status. He is HIV-negative with a past medical history of recent orthotopic liver transplantation. The patient has not traveled outside the Midwest and has no recent known animal or outdoor exposures.
Blood, cerebrospinal fluid (CSF) and a right thigh biopsy were submitted to the microbiology laboratory for bacterial and fungal stains and cultures. The thigh biopsy and the positive blood culture demonstrated encapsulated yeast on direct specimen stain, and all 3 specimens grew the same fungi, which was identified by MALDI-TOF MS. Serum and CSF were submitted to the microbiology laboratory for a particular antigen test, which was positive. The right thigh biopsy was also submitted for surgical pathology staining, which revealed budding yeast that were highlighted by Mucicarmine and Fontana-Masson stains.

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Author Information

Nicole J. Tarlton, Ph.D., Clinical and Public Health Microbiology Fellow, Washington University School of Medicine
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