Case 83

1. Presented by Regina Kwon, MD and reviewed by Sean Zhang, MD, PhD

An adult patient with a history of tuberculosis and COVID-19, presented with an unintentional weight loss of 40 pounds and daily fevers of unknown origin. After admission, they developed severe abdominal pain and was found to have a perforated bowel. Biopsies taken during the surgical repair showed granulomatous inflammation. A peritoneal fluid sample grew coagulase-negative Staphylococcus aureus and Weisella confusa.
Two weeks later, the patient had a second bowel perforation. The surgeon submitted portions of bowel wall and mesenteric lymph node for culture. These samples grew both Candida albicans and Candida kefyr.
One month later, they developed worsening abdominal pain and fever, and peripheral blood and blood from a central line were sent for bacterial and fungal cultures. On the eighth day, the fungal culture demonstrated the following:
Fig. 1. Growth after eight days at 37°C.

Fig. 2. Wet mount of organism.

Q. What additional information would best support your identification of this organism?


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