Soon after the first case, C. dubliniensis was isolated from a sputum culture and bronchial alveolar lavage cultures from a 50-year-old Chinese woman, who had myelodysplastic syndrome and was hospitalized for pneumonia. She had been previously treated with chemotherapy and had multiple admissions for infection. The same phenotypic and karyotypic methods as the first patient were used to identify the isolate. The API 20C AUX profile was 2152134 at 48 hours (98.5% certainty for C. dubliniensis). The MIC of fluconazole by E-test was also 0.75 mug/mL. Pancytopenia developed, and the patient's condition deteriorated. She died of pneumonia despite transfusions and treatment with broad-spectrum antibiotics and amphotericin B. Microbiologic investigations for bacteria, tuberculosis, pneumocystis, Legionella, and viruses did not yield positive results except for Corynebacterium species in the bronchial alveolar lavage fluid.
Although C. dubliniensis was first associated with oral candidiasis in HIV-infected persons, several reports now link the organism to non-HIV patients who were immunosuppressed due to chemotherapy, hematologic malignancy, and end-stage liver disease. Our two patients were not HIV positive but were immunosuppressed. In vitro susceptibility results showed that our patients should have responded to the usual antifungal treatment. However, they died despite appropriate therapy.