Nosocomial infections are a leading complication of prolonged extracorporeal membrane oxygenation (ECMO) therapy, and invasive fungal infections are of particular concern.¹ Candida bloodstream infection specifically is associated with poor outcomes in acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) and in lung-transplant recipients.^2,3 Here, we present a case of a 27-year-old man who transferred to be evaluated for lung transplantation in November 2021 and developed recurrent candidemia. He initially presented to an outside hospital with COVID-19 that September, developed ARDS, and was placed on VV-ECMO 5 days after intubation. Three weeks following transfer, he developed increasing leukocytosis (white blood cell count [WBC] 24,000/µL). Blood cultures grew Candida albicans. He was started on micafungin at an increased dose of 200 mg daily due to extraction of micafungin by the ECMO circuit,⁴ but daily blood cultures remained positive. All central lines were removed except for his right internal jugular vein 29 French ProtekDuo (LivaNova, London, United Kingdom) ECMO cannula. Cultures initially cleared, but his leukocytosis worsened, peaking with WBC 33,000/µL. Subsequently, his oxygenator, with fibers comprised of polymethylpentene (Maquet Quadrox oxygenator, Getinge, Sweden) was noted to have visual signs of fungal growth (Figure 1). Consequently, the ECMO oxygenator and tubing were exchanged, but the ECMO cannula was left in place.