(506) Rhodotorula glutinis: An Emerging Pathogen in CNS Infections

Introduction: Rhodotorulae, a type of yeast belonging to the family Cryptococcaceae and subfamily Rhodotorulodeae, are commonly found in the skin, lungs, urine, and feces. Notably, Rhodotorula species, along with Cryptococcus species, share numerous morphological and physiological traits, leading to occasional misidentification. Until recently, Rhodotorula, like other similar microorganisms, was considered non-pathogenic. However, there have been emerging reports implicating Rhodotorula spp. in various infections, including meningitis, endocarditis, ventriculitis, peritonitis, fungemia, central venous catheter infections, and keratitis. Meningitis caused by Rhodotorula is relatively uncommon, with only a few cases documented in the literature. In most cases of central nervous system (CNS) infection, an underlying immunocompromised state was observed, often resulting in increased mortality. Here, we present a unique case of a patient with a hematological malignancy who developed a central nervous system infection caused by Rhodotorula glutinis.

Description: A 38-year-old male with history of HTLV-associated T-cell lymphoma presented with productive cough and chest wall pain. He had completed three cycles of chemotherapy. Ultimately, he developed septic shock secondary to fungemia and cryptococcal meningitis, requiring intubation and admission into the intensive care unit. Blood cultures grew Cryptococcus neoformans/gatti and CSF cultures grew Rhodotorula glutinis and Cryptococcus laurentii. The patient received amphotericin B, flucytosine, and fluconazole but ultimately underwent cardiac arrest.

Discussion: CNS infections associated with Rhodotorula glutinis might be underreported due to its misidentification as C. neoformans during microscopy and its classification as a sample contaminant. Therefore, it is crucial to routinely culture all positive India ink preparations to confirm the pathogenic role of these uncommon yeasts. Early identification of R. glutinis as the causative agent of meningitis in immunocompromised patients is essential for enhancing treatment outcomes. Further research is warranted to elucidate the pathogenesis of this uncommon fungus and gain a better understanding of appropriate therapeutic options for its management.