Papiliotrema Laurentii Bloodstream Infection Following Methylprednisolone Pulse Therapy for Respiratory Syncytial Virus-Associated Acute Encephalopathy in a Child

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Papiliotrema laurentii is an environmental yeast that has been increasingly recognized as a cause of invasive infections, particularly in individuals with impaired cellular immunity.However, reports in Japan are limited.We describe a rare case of bloodstream infection caused by Papiliotrema laurentii in a 4-year-old Japanese girl with cerebral palsy and epilepsy.She was diagnosed with respiratory syncytial virusassociated acute encephalopathy, and received methylprednisolone pulse therapy as part of intensive management.Despite completion of the 3-day steroid therapy, her fever persisted.Subsequent blood cultures performed 3 days after steroid therapy completion revealed the presence of yeast-like organisms.The isolate was identified as Papiliotrema laurentii using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and sequencing of the internal transcribed spacer and D1/D2 regions.Antifungal susceptibility testing revealed a characteristic profile distinct from that of common yeasts.Micafungin was switched to liposomal amphotericin B and later to fosfluconazole, resulting in complete resolution.The patient remained relapse-free at the 6-month follow-up.To our knowledge, this is the first reported case of Papiliotrema laurentii fungemia in Japan; however, its true incidence may be underestimated because of diagnostic limitations and limited surveillance data.This case suggests that methylprednisolone pulse therapy may predispose even immunocompetent children to opportunistic fungemia and that accurate identification and susceptibility testing are essential for appropriate antifungal management.

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