A Unique Case of Candida auris Infection Presenting With Hydropneumothorax and Bronchopleural Fistula: A Diagnostic and Therapeutic Challenge

Candida auris is an emerging multidrug-resistant fungal pathogen that has become a significant global health concern, particularly in critically ill patients within hospital settings. It is known for its high mortality rates, diagnostic challenges, and frequent misidentification, which delays appropriate treatment. We present a case of a 72-year-old male with diabetes and hypertension who initially presented with a persistent cough, hemoptysis, and fever and was initially suspected of having pulmonary tuberculosis. Despite tests negative for tuberculosis, empirical anti-tubercular treatment and antibiotics were initiated. However, subsequently, the patient deteriorated, developing hydropneumothorax and bronchopleural fistula, suggesting a different diagnosis. Advanced fungal cultures from endotracheal secretions later confirmed Candida auris infection. Given the concern for antifungal resistance, initial treatment with caspofungin was switched to posaconazole, leading to marked clinical improvement. After 21 days of hospitalization, the patient was discharged and continued posaconazole for two months, with full recovery by the three-month follow-up. This case represents the first reported instance of Candida auris infection complicated by hydropneumothorax and bronchopleural fistula, a rare and severe pulmonary manifestation. It underscores the diagnostic difficulties associated with Candida auris, which often mimics other infections like tuberculosis, and highlights the importance of advanced diagnostic techniques. The case also emphasizes the utility of posaconazole in managing resistant Candida auris infections and the need for heightened clinical suspicion of this pathogen in critically ill patients who do not respond to conventional therapies.