title: Trichosporon inkin as an Emergent Pathogen in Patients With Severe Pemphigus.
abstract: OBJECTIVE
  To our knowledge, these are the first reports of bloodstream infections by Trichosporon inkin in patients with pemphigus.
  
  
  METHODS
  Trichosporon inkin, a novel organism causing bloodstream infection, was detected in 2 patients with pemphigus. An elderly man with pemphigus foliaceus died despite treatment with liposomal amphotericin B, 3 mg/kg/d, and a young girl with pemphigus vulgaris responded to treatment with voriconazole, 8 mg/kg/d, for 24 days. One of the T inkin isolates had a minimal inhibitory concentration of 2 mg/L against amphotericin B, suggesting resistance to the drug.
  
  
  CONCLUSIONS
  Delayed suspicion of invasive infection by T inkin may result in a poor outcome in patients with severe forms of pemphigus. This opportunistic infection is highly refractory to conventional potent antifungal treatment.
authors.affiliation: Central Laboratory Division, LIM 03, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: João
authors.initials: J
authors.lastname: Nobrega de Almeida Júnior
authors.affiliation: Laboratory of Medical Mycology (LIM 53), Division of Dermatology Clinic, Hospital das Clínicas da Faculdade de Medicina da Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Buccheri de Oliveira
authors.affiliation: Pathology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Amaro
authors.initials: A
authors.lastname: Duarte
authors.affiliation: Central Laboratory Division, LIM 03, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Lopes Motta
authors.affiliation: Central Laboratory Division, LIM 03, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Flávia
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Central Laboratory Division, LIM 03, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Dulce
authors.initials: D
authors.lastname: Sachiko Yamamoto de Figueiredo
authors.affiliation: Laboratory of Medical Mycology (LIM 53), Division of Dermatology Clinic, Hospital das Clínicas da Faculdade de Medicina da Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Gilda Maria
authors.initials: GM
authors.lastname: Barbaro Del Negro
authors.affiliation: Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Valeria
authors.initials: V
authors.lastname: Aoki
authors.affiliation: Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Celina
authors.initials: C
authors.lastname: Wakisaka Maruta
authors.affiliation: Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Claudia
authors.initials: C
authors.lastname: Giuli Santi
authors.affiliation: Laboratory of Medical Mycology (LIM 53), Division of Dermatology Clinic, Hospital das Clínicas da Faculdade de Medicina da Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Gil
authors.initials: G
authors.lastname: Benard
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D025141:Drug Resistance, Fungal; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D010392:Pemphigus / Q000188:drug therapy* / Q000473:pathology; D012720:Severity of Illness Index; D014250:Trichosporon / Q000187:drug effects / Q000302:isolation & purification*; D060586:Trichosporonosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole