Background: Systemic Malassezia furfur (Mf) infections are only seen in neonates and immunocompromised patients.
Case report: A 2-year-8-month-old boy was given chemotherapy for mediastinal T cell lymphoma. Meningeal relapse supervened 10 months later, requiring polychemotherapy plus CNS irradiation followed by bone marrow transplantation. Three days after transplantation, fever associated with neutropenia required administration of ceftazidime, amikacin, vancomycin plus acyclovir followed by amphotericin B, cefotaxime plus erythromycin. Blood cultures were negative, but blood swears showed yeasts into polynuclear cells after cytocentrifugation; these yeasts were also present in the central catheter removed after a few days course of amphotericin B, flucytosine plus fluconazole. The patient was then given GM-CSF subcutaneously (5 micrograms/kg/day), followed by progressive correction of aplasia and cure of the Mf infection.
Conclusion: This is a new case of systemic Mf infection seen in an immunocompromised child receiving parenteral nutrition with lipids.