A 79-year-old female with a history of recurrent urinary tract infections, diabetes, and bladder cancer presented with persistent funguria despite fluconazole treatment. Initial urine cultures grew Candida albicans, but subsequent cultures after fluconazole showed yeast identified as Trichosporon asahii by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). The patient remained asymptomatic, and the funguria resolved spontaneously without further antifungal therapy, suggesting colonization rather than active infection. This case highlights the importance of accurate yeast identification in urine and careful clinical correlation to differentiate colonization from true infection, avoiding unnecessary treatment.
Key note: Accurate identification of urinary yeast is crucial, but clinical correlation is essential to distinguish colonization from true infection and prevent overtreatment.