Multifocal Trichosporon asahii Infection in a Patient With Chronic Granulomatous Disease

Abstract

A 20-year-old female with chronic granulomatous disease (CGD) presented with a 10-day history of left hip pain and intermittent fever to an outpatient clinic in the Midwestern United States. She reported constant, moderate to severe pain over the posterior aspect of the left hip with distal radiation that improved with movement. She denied any joint swelling, decrease in range of motion, discoloration, rash, or edema. A review of systems was significant for a nonproductive cough without dyspnea and a 3-kg weight loss during the last 4 months. The patient’s CGD resulted from biallelic pathogenic variants in the neutrophil cytosolic factor 1 (NCF1) gene, an autosomal-recessive form of CGD. She was originally from the United Arab Emirates (UAE) and had arrived in the United States 30 days before presentation for allogeneic hematopoietic stem cell transplantation (HSCT) evaluation. Previous history was notable for Streptococcus intermedius liver abscess treated 4 years before presentation. She denied any significant animal exposure or known exposure to individuals with active tuberculosis infection. She had poor adherence to her previously prescribed itraconazole and trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis regimen.