A rare case of cutaneous Trichosporon asahii infection in an immunocompromised child

Abstract

We present an 11-year-old girl who developed neutropenic fever and papulonodular lesions over her limbs and back following chemotherapy for relapsed acute myeloid leukemia. She was found to have cutaneous Trichosporon asahii infection, with no evidence of systemic infection, and responded to treatment with voriconazole. T. asahii infection is rare but often fatal and usually causes disseminated infections in immunocompromised patients. Cutaneous infection is relatively uncommon and rarely occurs in the pediatric population.

Breakthrough Trichosporon asahii in a Patient With New Diagnosis B-ALL on Echinocandin Prophylaxis: A Case Report

“…11,19 Skin involvement is common, often with hemorrhagic painless macules, papules, or nodules on the trunk, face, and extremities. 13,15,16,20 Lung involvement in disseminated disease is a significant contributor to morbidity and mortality, as seen in this case, with heart, spleen, liver, and kidney involvement also observed. 13,19,20 Voriconazole is the agent of choice and is superior to amphotericin B; echinocandins have minimal activity against T. asahii.…”

“…In immunocompetent hosts, Trichosporon species typically cause allergic pneumonitis or superficial skin infections—immunosuppressed patients, particularly those with profound neutropenia related to treatment for a hematologic malignancy or disorder, may develop invasive disease with a mortality rate as high as 70% 11,19. Skin involvement is common, often with hemorrhagic painless macules, papules, or nodules on the trunk, face, and extremities 13,15,16,20. Lung involvement in disseminated disease is a significant contributor to morbidity and mortality, as seen in this case, with heart, spleen, liver, and kidney involvement also observed 13,19,20.…”

“…Here we highlight this need for caution as we present a case of breakthrough Trichosporon asahii in a patient with new diagnosis B-ALL on echinocandin prophylaxis, as well as several other breakthrough cases of T. asahii in children being treated for hematologic or oncologic diseases from the literature. 1,[12][13][14][15][16]…”