Trichosporonosis in a patient with acute leukaemia

The genus Trichosporon spp. isolated in laboratories is associated with superficial infections or colonisation. In recent years this organism has emerged as an opportunistic pathogen, causing invasive and severe infections, particularly in patients with haematological malignancies and other medical conditions associated with immunosuppression. This article describes the clinical signs and diagnostic approach of a Trichosporon asahii infection in an immunocompromised host with a haematological malignancy who underwent chemotherapy treatment, and developed bone marrow aplasia and febrile neutropenia 9 days after it was started. It was necessary to begin antibiotic therapy; however, she persisted with fever and marrow aplasia 7 days after additional antifungal therapy was added. A high resolution tomography of the chest was performed that showed centrilobular micronodular infiltrates and some areas of ground glass opacities, with positive blood cultures for yeasts. The patient deteriorated clinically, requiring intensive care unit, due to severe sepsis with respiratory dysfunction, and the antibiotic escalating to carbapenem and changing of the antifungal therapy. Nodular skin lesions then erupted, on which biopsy was performed. Despite this medical management the patient developed multiple organ failure and died. The results of the blood cultures and skin biopsy were consistent with Trichosporon asahii.