Fatal fungemia by biofilm-producing in a liver transplant candidate.

Acute-on-chronic liver failure (ACLF) is often associated with a dismal outcome. Infections might preclude access to liver transplantation (LT) for these patients, further reducing their chance of survival. We report the case of a patient with ACLF who died before LT for biofilm-producing fungemia. The patient early started antifungal therapy with anidulafungin, but was not susceptible to echinocandins, delaying the start of active antifungal therapy. Although rare, invasive infections by spp. are associated with high mortality rates due to low antimicrobial susceptibility and production of biofilms on indwelling devices. Early diagnosis and treatment are crucial to reduce mortality and enhance patient survival.