Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient.
Trichosporon (T.) asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease. There is a strong possibility that our patient had been colonized at the infection site as part of the normal skin flora. After one-month bed rest due to an accidental fall and fracture of the right shoulder blade, a 61-year-old woman experienced severe edema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphedema. Samples collected from the affected areas revealed T. asahii and the patient was referred to a hospital for infectious diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted to our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the fatal outcome. Nowadays, physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.
Assist. Prof. Stavroula Baka, MD, 3, Blessa Street, Papagou, 15669 Athens, Greece; sbaka@aretaieio.uoa.gr.
Stavroula
S
Baka
Iliana
I
Tsouma
Evangelia
E
Kouskouni
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage; D003881:Dermatomycoses / Q000382:microbiology*; D004487:Edema / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007121:Immunocompetence; D007866:Leg / Q000382:microbiology; D008875:Middle Aged; D060586:Trichosporonosis / Q000175:diagnosis* / Q000188:drug therapy; D065819:Voriconazole / Q000008:administration & dosage
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole