Abstract
Background: Trichosporonosis is an emerging invasive opportunistic fungal infection in immunocompromised patients. Case presentation: We report an unusual clinical presentation of a rare invasive fungal infection secondary to Trichosporon asahii in a 26-year-old female. This was initially a known case of Systemic Lupus Erythematosus (SLE). The patient presented with abdominal pain and distension secondary to bowel perforation. She was admitted for urgent sigmoid resection and colostomy. The surgical histopathology reported excessive infiltration of fungal elements but was inconclusive. The patient was started on ambisome; PCR then showed Trichosporon species and later the blood culture grew yeast for which caspofungin was added. However, the final identification was that of Trichosporon asahii, which is resistant to echinocandins and sensitive to amphotericin B and voriconazole. The patient stayed in the ICU for more than one month. She received broad-spectrum antibiotics and had a central venous catheter, arterial, and Quinton lines inserted for an average duration of 30 days. Ultimately, the patient died due to disseminated infection, multiple episodes of ICU acquired infections, and multi organ failure. This is the first case of Trichosporon in a SLE patient to be reported from Saudi Arabia, Riyadh at the Prince Sultan Military Medical City. Conclusion: Trichosporon is an opportunistic fungal infection that requires a high index of clinical suspicion. Molecular diagnosis is a rapid, highly sensitive and reliable diagnostic tool that plays a crucial role in speeding up diagnosis.
Highlights
BACKGROUNDTrichosporon asahii is yeast originating from the Basidiomycetes class. It is considered a life-threatening opportunistic pathogen, most prominently for neutropenic and immunocompromised patients [1]
Trichosporonosis is an emerging invasive opportunistic fungal infection in immunocompromised patients
Based on the overall clinical context of the patient’s condition, she was started on liposomal amphotericin 5 mg/kg to cover the high possibility of invasive fungal infections, namely Mucor mycosis
Summary
Trichosporon asahii is yeast originating from the Basidiomycetes class. It is considered a life-threatening opportunistic pathogen, most prominently for neutropenic and immunocompromised patients [1]. A clinical examination revealed a temperature of 36.1 degrees, a pulse of 114/min, blood pressure of 115/55, and a respiratory rate of 16/min with normal O2saturation at room air Based on the overall clinical context of the patient’s condition, she was started on liposomal amphotericin 5 mg/kg to cover the high possibility of invasive fungal infections, namely Mucor mycosis. This usually tends to manifest as profuse bleeding due to severe angioinvasion, which is characteristic in a high risk group of patients. The post-surgery patient became tachypnoeic and desaturated She was intubated with Fio of 40% and there were blood tinged secretions from the endotracheal tube. The yeast isolated from the blood culture was identified as a Trichosporon species using API 20C AUX (bioMerieux, Mercy l’Etoile, France), which was sensitive only to voriconazole and flucytosine using Sensititre YeastOne® (Thermo Scientific) (Figures 2 and 3)
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