Paecilomyces lilacinus fungemia in an adult bone marrow transplant recipient

Paecilomyces lilacinus is a rare fungal pathogen in humans. We report a cas e of fungemia caused by P. lilacinus in a non-neutropenic adult, 120 days a fter bone marrow transplant. The patient's primary risk factor was the pres ence of an indwelling vascular catheter. Her initial clinical course was ch aracterized by fever, chills, and rigors. Blood cultures from the central l ine and peripheral veins were positive, as was a peripheral specimen drawn after removal of the catheter. Two initial peripheral specimens were positi ve for P. lilacinus only by blind subculture and/or sustained incubation. S he developed peripheral pulmonary nodules following the fungemia, thus rais ing the possibility of disseminated disease, but definitive diagnosis was c onfounded by Pseudomonas bacteremia. The nodules cleared and she recovered following removal of the central line and treatment with amphotericin B and fi-fluorocytosine, despite in vitro resistance to these antifungal drugs. This case underscores the increasing importance of P. lilacinus as a human pathogen capable of producing disease in immunocompetent, as well as in imm unocompromised hosts. Also of note is that blood culture systems may requir e extended incubation or subcultures in order to detect fungi.