Introduction: We present a fatal case of disseminated infection in a child with leukaemia, caused by Saprochaete capitata, an ascomycetous yeast.Case presentation: The aetiological role of disseminated infection by S. capitata in a child with relapsed acute myeloid leukaemia following bone-marrow transplantation was established by its repeated isolation from blood, tracheal secretion and urine samples. The identity of S. capitata was confirmed by phenotypic and molecular methods. The isolate showed reduced susceptibility to caspofungin. Conclusion:This report indicates that patients receiving echinocandin prophylaxis are at risk of breakthrough infections caused by S. capitata or other arthroconidial yeast species. To the best of our knowledge, this is the first well-documented case of S. capitata infection from the Middle East.Keywords: Breakthrough infection; echinocandins; fungaemia; Saprochaete capitata. IntroductionSaprochaete capitata, an anamorph of Magnusiomyces capitatus (de Hoog & Smith, 2004), previously known as Geotrichum capitatum or Blastoschizomyces capitatus, is a rarely reported cause of disseminated disease (Girmenia et al., 2005). It is known to colonize the respiratory and digestive tracts of humans and appears to have similar pathogenesis to other yeast species colonizing mucosal surfaces (Birrenbach et al., 2012). Most cases of S. capitata infection have occurred in patients with haematological malignancies and persistent neutropenia receiving chemotherapy (Fouassier et al., 1998;Martino et al., 2004;Girmenia et al., 2005;Miceli et al., 2011; Lafayette et al., 2011;Ö zkaya-Parlakay et al., 2012;García-Ruiz et al., 2013). Disseminated S. capitata, infection is associated with high mortality, thus underscoring the need for accurate identification, prior antifungal susceptibility testing and early initiation of specific therapy (Girmenia et al., 2005). Here, we describe a fatal case of breakthrough S. capitata infection in a child who was on empirical caspofungin therapy. Case reportAn 11-year-old Egyptian female, a known case of acute myeloid leukaemia since December 2009, underwent allogeneic bone-marrow transplantation in August 2011. She was admitted for a relapse and received chemotherapy with fludarabine, L-asparaginase and idarubicin. During chemotherapy, she developed fever, cough, renal impairment and bacteraemia with Stenotrophomonas maltophilia (susceptible to cotrimoxazole and colistin), and she was transferred to the paediatric intensive care unit (PICU) and started on colistin, caspofungin and metronidazole. During her PICU stay, she remained severely neutropenic (absolute neutrophil count ,100 mm 21 ) and experienced two more episodes of bacteraemia, one due to Staphylococcus epidermidis and the other due to Stenotrophomonas maltophilia from blood drawn through the Port-A-Cath. For these infections, she was treated with teicoplanin, colistin, meropenem, clarithromycin and cotrimoxazole. Caspofungin was added empirically in the treatment regimen. The Port-A-Cath was not change...

Congenital leukaemia (CL) is a rare malignancy that accounts for < 1% of cases of childhood leukaemias. Leukaemia cutis (LC) refers to cutaneous infiltration with leukaemic cells, and is seen in 30-50% of CL cases. It may precede, follow or occur simultaneously with leukaemia. If left untreated, the prognosis is usually poor, but early diagnosis and treatment may result in a favourable prognosis. We report a case of congenital leukaemia cutis with a progressive, violaceous papulonodular eruption (a 'blueberry muffin' rash), which had been noted at birth, as a presenting sign of acute myeloid leukaemia (AML), which on investigation was classified as AML, FAB M2 type with a t(8; 21)(p11;q22) chromosomal defect. The patient had a favourable response to AML chemotherapy.