Breakthrough invasive disseminated cryptococcal fungemia in a patient receiving micafungin therapy: a case report

Micafungin is an echinocandin-class antifungal agent that is extremely used in the recent era due to minimal toxicity and broad-spectrum activity, unfortunately, has limited ability against Cryptococcus neoformans. Since it’s inherently resistant, indeed disseminated invasive cryptococcosis is becoming an essential issue in echinocandin recipient with impaired immunity. We present a patient with systemic lupus erythematosus and miliary tuberculosis, who developed a fungal infection with invasive cryptococcal fungemia during empirical micafungin therapy. To the best our knowledge, breakthrough disseminated cryptococcosis has not been reported, as seen in our patient. This case highlighted that Cryptococcus neoformans infection should be kept in mind as a possible breakthrough infection while receiving echinocandin, especially in patients with cellular immunodeficiency.