Treatment of Candida nivariensis Blood Stream Infection With Oral Isavuconazole

Candida nivariensis is a rarely isolated yeast that is now considered a species within the Candida glabrata complex. Anti-fungal susceptibilities and treatments of Candida nivariensis are often assessed on a case-by-case basis. In this case, a 70-year-old male with a complex medical history presented to a large academic medical center in the United States for vascular surgery. After surgery, the patient’s white blood cell count increased prompting an infectious workup. The patient was found to have a Candida nivariensis bloodstream infection of unknown origin. Given the patient’s clinical stability and QTc prolongation, he was treated with a 14-day course of oral isavuconazole. The patient experienced resolution of symptoms and clearance of subsequent blood cultures. At the time of writing this case report (11 months later), he has had no relapse of his fungal infection. Based on a search of the medical literature, this appears to be the first published case of Candida nivariensis fungemia successfully treated with oral isavuconazole.