Abstract Body (Do not enter title and authors here): BACKGROUND
Fungal endocarditis is uncommon, making up an estimated 1-3% of cases. Risk factors for this are prosthetic heart valves, prior heart surgery, and IV drug use. Fungal seeding of CIED is even more rare, and often leads to fatal outcomes. The majority of the species involved are Candida. Pichia kudriavzevii, formerly known as Candida krusei, is a rare non-Candida species of yeast that is most frequently seen in immunocompromised patients and is associated with a high mortality rate. Known risk factors for P. kudriavzevii include underlying gastrointestinal disease or cancer, hematologic malignancies, organ transplant, corticosteroid use, and recent use of antibiotic or antifungal therapies. We present the case of P. kudriavzevii fungemia leading to seeding of ICD.

CASE REPORT
A 66-year-old male with past medical history of uncontrolled type 2 diabetes mellitus, non-ischemic cardiomyopathy with dual chamber ICD, and atrial fibrillation s/p re-do CTI and PVI ablation 2 months prior presented to the ED with abdominal pain, vomiting, and dysuria. He was afebrile and hemodynamically stable. Workup revealed WBC count of 28.6, blood glucose of 361. CT imaging of the abdomen and pelvis was unremarkable. He was admitted for sepsis secondary to suspected UTI and was started on ceftriaxone. Blood cultures drawn on admission resulted showing Pichia kudriavzevii and Lactobacillus gasseri. Urine cultures resulted showing showing P. kudriavzevii. The patient was then started on micafungin. Initial TTE did not reveal vegetations, LVEF noted to be 55%. A TEE was ordered as the patient was having persistent unexplained leukocytosis, and this revealed a vegetation on the ICD lead in the right atrium. Given the patient’s fungemia with evidence of endovascular seeding and vegetations, in the context of now recovered LVEF, the patient underwent complete extraction of his ICD.

CONCLUSIONS
This case is unique in that the patient seemingly has no major risk factors for P. kudriavzevii fungemia. He does not have history of prior fungal infections or UTIs, recent anti-fungal or antibiotic use, or immunocompromised status. The patient did undergo a recent CTI and PVI ablation, however the source of infection was proven to be urinary. His uncontrolled diabetes mellitus may have been a contributing factor. A multidisciplinary approach involving infectious disease and cardiology is critical in reducing the risk of adverse outcomes in these patients.