An immunocompromised patient developed severe fungemia and hepatosplenic lesions caused by Saprochaete capitata, despite receiving micafungin as antifungal prophylaxis. The patient, likely with an underlying hematologic malignancy, presented with persistent infection that proved resistant to standard echinocandin therapy. Diagnosis was confirmed through blood cultures and imaging revealing disseminated fungal lesions. This case highlights the challenges in managing opportunistic infections in vulnerable populations and the potential for breakthrough infections with unusual pathogens. The organism's resistance profile necessitated a change in antifungal regimen.
Key note: Saprochaete capitata can cause breakthrough infections in immunocompromised patients on echinocandins, requiring careful consideration of alternative antifungal agents.