{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:09:52Z","timestamp":1776082192176,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Candida dubliniensis is an opportunistic yeast closely related to Candida albicans and an uncommon cause of central nervous system (CNS) infection. While isolates are often susceptible to azoles, reduced susceptibility or acquired resistance may occur, making species identification and antifungal susceptibility testing clinically relevant. We report a 3-year-old boy with Philadelphia chromosome-positive B-cell precursor acute lymphoblastic leukemia (ALL) in hematologic remission who developed chronic meningitis during maintenance chemotherapy. The initial presentation was non-specific (marked somnolence without fever or meningeal signs) and lumbar puncture performed to exclude CNS relapse revealed neutrophil-predominant pleocytosis and elevated protein; the cerebrospinal fluid (CSF) culture grew C. dubliniensis. Treatment with intravenous liposomal amphotericin B followed by prolonged fluconazole led to clinical improvement and sterile CSF. Six months later, progressive gait disturbance, limb pain, and episodic severe headaches recurred; repeat CSF cultures again yielded C. dubliniensis, with a changed susceptibility profile. Spine MRI demonstrated leptomeningeal enhancement involving the cauda equina nerve roots. Intravenous voriconazole with therapeutic drug monitoring was initiated and combined with intrathecal liposomal amphotericin B (seven doses, dose-escalated up to 3 mg), which was well tolerated and associated with rapid neurologic improvement, CSF sterilization, and radiologic resolution. At 12 months of follow-up, the patient remained infection-free and in leukemia remission. This case highlights that C. dubliniensis chronic meningitis may present subtly yet progress, requiring repeated CSF cultures with susceptibility testing; intrathecal liposomal amphotericin B can be a safe and effective adjunct to systemic therapy in refractory or recurrent disease.<\/jats:p>","DOI":"10.3390\/pediatric18020055","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T10:19:14Z","timestamp":1776075554000},"page":"55","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Candida dubliniensis as a Cause of Chronic Meningitis in a 3-Year-Old Boy with Acute Lymphoblastic Leukemia"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6963-9329","authenticated-orcid":false,"given":"Adrianna","family":"\u0106wiertnia","sequence":"first","affiliation":[{"name":"Doctoral School, Pomeranian Medical University in Szczecin, \u017bo\u0142nierska 54, 71-210 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Chuchla","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Hemato-Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomasz","family":"Ociepa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Hemato-Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/2162-3619-3-16","article-title":"Childhood B-acute lymphoblastic leukemia: A genetic update","volume":"3","author":"Woo","year":"2014","journal-title":"Exp. Hematol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"950","DOI":"10.15585\/mmwr.mm6636a3","article-title":"Rates and Trends of Pediatric Acute Lymphoblastic Leukemia\u2014United States, 2001\u20132014","volume":"66","author":"Siegel","year":"2017","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3345\/kjp.2011.54.3.106","article-title":"Philadelphia chromosome-positive acute lymphoblastic leukemia in childhood","volume":"54","author":"Koo","year":"2011","journal-title":"Korean J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lejman, M., Cha\u0142upnik, A., Chilimoniuk, Z., and Dobosz, M. (2022). Genetic Biomarkers and Their Clinical Implications in B-Cell Acute Lymphoblastic Leukemia in Children. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23052755"},{"key":"ref_5","unstructured":"(2023, December 12). Infection-Related Mortality in Children with Acute Lymphoblastic Leukemia: An Analysis of Infectious Deaths on UKALL2003-PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/24904116\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2021039","DOI":"10.4084\/MJHID.2021.039","article-title":"Invasive Fungal Diseases in Children with Acute Leukemia and Severe Aplastic Anemia","volume":"13","author":"Supatharawanich","year":"2021","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_7","first-page":"94","article-title":"Invasive Fungal Infections in Children with Leukemia: Clinical Features and Prognosis","volume":"39","author":"Evim","year":"2022","journal-title":"Turk. J. Hematol."},{"key":"ref_8","first-page":"228","article-title":"Lymphocytic meningitis after intrathecal liposomal cytarabine in a patient with acute lymphoblastic leukemia","volume":"8","author":"Warzocha","year":"2017","journal-title":"Hematol. Clin. Pract."},{"key":"ref_9","unstructured":"(2026, March 30). Neurological Toxicities Among Children Patients During Treatment for Acute Lymphoblastic Leukemia and Occurrence of Neuropsychological Late Effects After the Treatment. Available online: https:\/\/www.termedia.pl\/Neurological-toxicities-among-children-patients-during-treatment-for-acute-lymphoblastic-leukemia-and-occurrence-of-neuropsychological-late-effects-after-the-treatment,63,24784,1,1.html."},{"key":"ref_10","unstructured":"(2023, December 12). The Presence of Fluconazole-Resistant Candida dubliniensis Strains Among Candida albicans Isolates from Immunocompromised or Otherwise Debilitated HIV-Negative Turkish Patients-PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/12716231\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1111\/odi.12123","article-title":"Identification of Candida species in the clinical laboratory: A review of conventional, commercial, and molecular techniques","volume":"20","author":"Neppelenbroek","year":"2013","journal-title":"Oral Dis."},{"key":"ref_12","unstructured":"(2023, December 12). Candida dubliniensis, a New Fungal Pathogen-PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/12111748\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e01665","DOI":"10.1016\/j.idcr.2022.e01665","article-title":"Candida dubliniensis chronic meningitis in an immunocompetent patient: Case report and literature review","volume":"31","author":"Price","year":"2022","journal-title":"IDCases"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e01564-17","DOI":"10.1128\/JCM.01564-17","article-title":"Update from a 12-Year Nationwide Fungemia Surveillance: Increasing Intrinsic and Acquired Resistance Causes Concern","volume":"56","author":"Astvad","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_15","unstructured":"(2024, June 11). Onkologia po Dyplomie-Inwazyjne Zaka\u017cenia Grzybicze: Strategie Post\u0119powania w Onkologii i Hematologii. Available online: https:\/\/podyplomie.pl\/onkologia\/17164,inwazyjne-zakazenia-grzybicze-strategie-postepowania-w-onkologii-i-hematologii."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"483","DOI":"10.5603\/AHP.a2021.0025","article-title":"High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: Adverse role of post-transplant CMV replication","volume":"52","author":"Dziedzic","year":"2021","journal-title":"Acta Haematol. Pol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1086\/313987","article-title":"Candidal Meningitis in Children with Cancer","volume":"31","author":"McCullers","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","first-page":"3221","article-title":"European guidelines for primary antifungal prophylaxis in adult haematology patients: Summary of the updated recommendations from the European Conference on Infections in Leukaemia","volume":"73","author":"Maertens","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e28035","DOI":"10.1002\/pbc.28035","article-title":"Comment on: Invasive fungal infections in children with acute lymphoblastic leukemia","volume":"67","author":"Castagnola","year":"2020","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1439-0507.2009.01759.x","article-title":"Candida albicans or Candida dubliniensis?","volume":"54","author":"Ells","year":"2011","journal-title":"Mycoses"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s11046-016-0006-7","article-title":"Meningitis Caused by Candida dubliniensis in a Patient with Cirrhosis: A Case Report and Review of the Literature","volume":"181","author":"Yamahiro","year":"2016","journal-title":"Mycopathologia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jmii.2012.10.001","article-title":"Catheter-related fungemia caused by Candida dubliniensis","volume":"46","author":"Lai","year":"2013","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_23","first-page":"e39031","article-title":"Candida dubliniensis Fungemia Leading to Infective Endocarditis and Septic Pulmonary Emboli","volume":"15","author":"Jafroodifar","year":"2023","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1111\/myc.13157","article-title":"Antifungal drugs: An updated review of central nervous system pharmacokinetics","volume":"63","author":"Wirth","year":"2020","journal-title":"Mycoses"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Tahir, M., Peseski, A.M., and Jordan, S.J. (2020). Case Report: Candida dubliniensis as a Cause of Chronic Meningitis. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.601242"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1016\/S1470-2045(20)30723-3","article-title":"8th European Conference on Infections in Leukaemia: 2020 guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation","volume":"22","author":"Groll","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e0215621","DOI":"10.1128\/aac.02156-21","article-title":"Challenges in the Treatment of Invasive Aspergillosis in Immunocompromised Children","volume":"66","author":"Hsu","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ashley, E.D. (2019). Antifungal Drugs: Special Problems Treating Central Nervous System Infections. J. Fungi, 5.","DOI":"10.3390\/jof5040097"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s40263-024-01065-4","article-title":"Early Experiences with Intrathecal Administration of Amphoteri-cin B Liposomal Formulation at a Neurosurgical Center","volume":"38","author":"Nailor","year":"2024","journal-title":"CNS Drugs"},{"key":"ref_30","first-page":"77","article-title":"Safety and tolerability of intrathecal liposomal amphotericin B (AmBisome) for cryptococcal meningitis: A retrospective study in HIV-infected patients","volume":"5","author":"Midde","year":"2018","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e27205","DOI":"10.1097\/MD.0000000000027205","article-title":"Candida meningitis in an infant after abdominal surgery successfully treated with intrathecal and intravenous amphotericin B: A case report","volume":"100","author":"Yuan","year":"2021","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"101092","DOI":"10.1016\/j.ajoc.2021.101092","article-title":"Medical and surgical treatment of rhi-no-orbital-cerebral mucormycosis in a child with leukemia","volume":"22","author":"Levinsen","year":"2021","journal-title":"Am. J. Ophthalmol. Case Rep."}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/2\/55\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:29:32Z","timestamp":1776079772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/2\/55"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,12]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["pediatric18020055"],"URL":"https:\/\/doi.org\/10.3390\/pediatric18020055","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,12]]}}}