CLINICAL CASE: WHEN IMMUNOSUPPRESSION HIDES THE TRUTH: STEPHANOASCUS CIFERRII INFECTION IN A PATIENT WITH SUSPECTED LYMPHOMA, INSTITUTO ONCOLOGICO DEL ORIENTE BOLIVIANO-SANTA CRUZ-BOLIVIA 2024.

Abstract

This clinical case involves a 39-year-old woman with a history of non-Hodgkin lymphoma who presented with bilateral proptosis, palpebral edema, conjunctival hemorrhage, and two months of progressive general deterioration. Initially suspected of oncological complications, advanced microbiological studies using the Vitek2® system confirmed an infection by Stephanoascus ciferrii, a rare opportunistic fungus in humans. The patient had previously undergone unsuccessful antibiotic treatments, highlighting the need for a more thorough diagnostic approach.

Management included antifungal therapy with amphotericin B and voriconazole, alongside ventilatory support in the intensive care unit due to severe acute respiratory distress syndrome and ventilator-associated pneumonia. The patient showed a favorable response, enabling her withdrawal from mechanical ventilation and gradual improvement until transfer to a general ward. This case underscores the importance of earlydiagnosis, multidisciplinary management, and consideration of rare fungal infections in immunocompromised patients, particularly when they fail to respond to standard therapies.

The experience emphasizes the need for an integrated approach in treating unusual infections and highlights the importance of guiding clinical management with further studies on these rare pathologies.