Mixed candidemia caused by Candida tropicalis and Candida krusei: A case report

Mixed fungemia, defined as the isolation of two or more fungal species from the same sample, is rare and often underdiagnosed. It represents a diagnostic and therapeutic challenge due to its high morbidity and mortality. We report the case of a 66-year-old patient with type 2 diabetes mellitus and hypertension, hospitalized for obstructive pyelonephritis complicated by hyperosmolar coma. The clinical course was marked by mixed candidemia due to Candida tropicalis and Candida krusei, identified only after 10 days of blood culture incubation. The antifungal susceptibility test revealed variable sensitivity to antifungal agents, with the natural resistance of C. krusei to fluconazole. Despite appropriate antifungal therapy, the patient died following septic shock. This case highlights the rarity and severity of mixed fungemia, as well as the importance of early and accurate diagnosis to optimize management and improve prognosis.