title: Trichosporon asahii fungemia in a patient with non-hematological malignancy.
abstract: Trichosporon fungemia is usually seen in neutropenic patients with underlying hematological malignancies. In this report we describe a fatal case of Trichosporon asahii fungemia in a non-neutropenic patient with a non-hematological malignancy. For 1 week the patient exhibited hematuria, weakness, easy fatigability and headaches. At admission she had anemia, renal failure and evidence of right hydronephrosis and bladder wall masses as detected by CT scan. She did not have a history of tobacco abuse, contact with urinary carcinogens or Schistosoma infestation; her clinical picture was suggestive of bladder cancer. After some investigations the patient underwent radical cystectomy and ileal conduit surgery because of transitional cell carcinoma in the urinary bladder. After an initial uneventful improvement postoperatively the patient deteriorated and died of septic shock despite all reanimation efforts and antibiotherapy including fluconazole. The blood culture obtained 4 days before the patient died revealed T. asahii, which was isolated on the day she died and found to be resistant to fluconazole and caspofungin. This report suggests that clinicians remain aware that T. asahii fungemia may develop in clinically deteriorated patients even if they do not have a hematological malignancy.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Izzet Baysal University, Faculty of Medicine, Bolu, Turkey. drkarabay@yahoo.com
authors.forename: Oguz
authors.initials: O
authors.lastname: Karabay
authors.forename: Miguel G
authors.initials: MG
authors.lastname: Madariaga
authors.forename: Esra
authors.initials: E
authors.lastname: Kocoglu
authors.forename: Nevin
authors.initials: N
authors.lastname: Ince
authors.forename: Engin
authors.initials: E
authors.lastname: Kandirali
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000601:surgery; D000077336:Caspofungin; D015653:Cystectomy / Q000379:methods; D026141:Drug Resistance, Multiple, Fungal; D054714:Echinocandins; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D055666:Lipopeptides; D008826:Microbial Sensitivity Tests; D010456:Peptides, Cyclic / Q000627:therapeutic use; D014250:Trichosporon / Q000187:drug effects / Q000302:isolation & purification*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D015725:Fluconazole; D000077336:Caspofungin