Histopathological examination is crucial to demonstrate invasiveness
of infection, but morphological identification of fungal
species should be avoided as it may misidentify the fungal element
[5]. It has been reported that in at least 20% of cases, misclassifications
of fungal organisms occur in histopathological examination
[6]. Yeast-mold differentiation is important for empirical
and definitive treatment of fungal infections as it affects the
choice of antifungal agent. In our case, based on the presumptive
histopathological diagnosis of candida infection, a therapeutic trial
with fluconazole was carried out as it has both parenteral and oral
formulations, is much cheaper than the other antifungal drugs and
has fewer side effects. However, patient’s condition did not improve
which necessitated switching to an extended-spectrum
antifungal agent. An echinocandin or voriconazole are possible
alternatives in this case, although the latter has an oral formulation
making it ideal for prolonged outpatient therapy. In our case,
voriconazole was well-tolerated by the patient and led to total
cure of mold infection after two and a half months of treatment