Azacitidine/voriconazoleTreatment failure: case report A 63-year-old man exhibited treatment failure during treatment with azacitidine for myelodysplastic syndrome (MDS). Additionally, he exhibited treatment failure during treatment with voriconazole for trichosporonosis secondary to Trichosporon asahii.The man, who had MDS, was hospitalised for induction chemotherapy due to progression of MDS to acute myeloid leukaemia (AML). He had received 5 cycles of azacitidine [route and dosage not stated] for MDS, which had been stopped due to treatment failure. Upon current presentation, he reported weight loss, fatigue and a productive cough with haemoptysis. He also reported an ingrown toenail which he had observed several weeks previously, and had since enlarged and become a non-tender mass lesion on the first digit on the right foot. He started receiving induction chemotherapy with daunorubicin liposomal [liposomal daunorubicin] and cytarabine. On hospital day 6, he became neutropenic. He was initiated on aciclovir [acyclovir], levofloxacin and posaconazole. By hospital day 18, he developed neutropenic fever [aetiology not stated] and was started on unspecified broad spectrum antibiotics. Due to increasing toe pain and erythema, he underwent several imaging and culture tests, which led to a diagnosis of trichosporonosis secondary to Trichosporon asahii. He started receiving IV voriconazole 6 mg/kg every 12 hours for trichosporonosis. Tissue cultures were also positive for Stenotrophomonas maltophilia and vancomycin-resistant Enterococcus faecalis. Amputation was recommended, but was deferred by his durable power of attorney. Despite voriconazole therapy, his infection source was not controlled. He ultimately developed septic shock and multi-organ failure leading to death attributed to ongoing trichosporonosis.