Severe Congenital Candidiasis due to Candida dubliniensis Treated With Fosfluconazole in a Preterm Infant

Congenital candidiasis is a rare but potentially lethal disease in preterm infants. Most cases are caused by Candida albicans; to date, there are no reports of Candida dubliniensis as the causative organism. Herein, we report a case of severe congenital candidiasis caused by C. dubliniensis in a very low-birth-weight infant. The patient was treated with fosfluconazole intravenously. However, candidiasis infection relapsed on Day 8 of life. Therefore, fosfluconazole administration was switched to 10 mg/kg/day of micafungin for the next 14 days as the inhibitory concentration of micafungin was lower than that of fluconazole. The candidiasis did not relapse again after discontinuation of micafungin. The patient was discharged on Day 59 without apparent sequelae. Some experiments have induced stable fluconazole resistance in vitro in fluconazole-sensitive C. dubliniensis strains after exposure to low concentrations of fluconazole. It may be advisable to consider an alternative antifungal drug when C. dubliniensis is a causative organism.