Discussion:
Rhodotorula remains a rare cause of infection. Previous reports
of disease caused by Rhodotorula have primarily been found in
immunocompromised hosts— such as the patient presented here with CVID
— with a majority of these involving CVC - associated infections. As
it is still not clear why some immunocompromised patients develop
complications such as Rhodotorula meningitis or endocarditis
whereas others simply have fungemia, patient history and clinical
presentation alone may not converge on Rhodotorula . Thus,
histopathologic evaluation remains essential to confirming diagnosis
and, as in this case, determining treatment course. There remains no
definitive treatment algorithm for Rhodotorula : suggested
treatments include simple supportive care, fluconazole, various
formulations and dosing regimens of amphotericin B, and
flucytosine/itraconazole combinations. As seen in our patient, these
regimens often cause complications due to their toxicities.
Additionally, this patient’s comorbidities, especially her coexisting
respiratory failure, were felt to have contributed to her poor outcome.
We hope the contribution of this novel manifestation ofRhodotorula as causing brain abscesses nonetheless serves as
another datapoint to hopefully improving the diagnosis and management of
this rare disease.