Abstract:Aureobasidium pullulans (A. pullulans) is a dark, yeast-like fungus, which is widespread in nature. As an opportunistic pathogen, A. pullulans extremely rare infects patient with normal immunity. This article reports a young immunocompetent woman infected with A. pullulans. The patient had normal immune function and presented with atypical clinical manifestations. Metagenomic next-generation sequencing (mNGS) of alveolar lavage fluid revealed the growth of A. pullulans. After antifungal treatment with voriconazole, patient improved significantly. Literature review revealed limited global report of such infection, including a total of 31 cases, with 20 male and 11 female patients aged from 4 months to 79 years old. Two patients had normal immunity without any known high-risk factors for infection, while others had a history of underlying diseases, secondary immune suppression, trauma, transplantation, and other diseases. The clinical manifestations were nonspecific and mainly related to the affected system. After antifungal treatment, 24 cases improved and recovered, while 7 cases died. In recent years, fungal infections have become increasingly common. Fungal infection caused by A. pullulans can affect various parts of the body, even in immunocompetent individuals. mNGS examination can effectively detect pathogens, thus enables timely diagnosis, shorter disease duration, and effective treatment.