ERG11 gene mutations and MDR1 up-regulation confer pan-azole-resistance in Candida tropicalis causing disseminated candidiasis while on posaconazole prophylaxis in an acute lymphoblastic leukemia patient [PublishAheadOfPrint]

In this study, we presented a rare case of fatal breakthrough Candida tropicalis in a patient with acute lymphoblastic leukemia (ALL) while on posaconazole prophylaxis. And then we explored the mechanisms underlying azole resistance by focusing on enhanced efflux pumps and changes in the azole target enzyme Erg11p, which was encoded by the ERG11 gene. Our study demonstrates that Y132C substitution of Erg11p combined with MDR1 overexpression may be the pan-azole-resistance mechanisms in Candida tropicalis.

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