Trichosporon asahii infection presenting as chronic meningo‐ventriculitis and intra ventricular fungal ball: a case report and literature review

Abstract

Central nervous system trichosporonosis is a rare clinical entity and so far only six cases including three each of brain abscess and meningitis has been on record. We report a rare case of chronic meningo-ventriculitis and intraventricular fungal ball due to Trichosporon asahii in an 18-year-old immunocompetent male from Burundi, east Africa. Neuroendoscopy showed multiple nodules and a fungal ball within the ventricle, which on culture grew T. asahii. He was initially empirically treated with liposomal amphotericin B. However, the antifungal susceptibility testing of T. asahii isolate revealed high minimum inhibitory concentration for amphotericin B (2 μg ml⁻¹), flucytosine (16 μg ml⁻¹) and caspofungin (2 μg ml⁻¹) but exhibited potent activity for voriconazole, posaconazole, itraconazole and fluconazole. The patient rapidly succumbed to cardiac arrest before antifungal therapy could be changed. Although disseminated trichosporonosis has been increasingly reported the diagnosis represents a challenge especially in rare clinical settings such as intraventricular fungal ball in the present case, which has not been described previously.

Neuroinfections caused by fungi

“…In cases of trichosporonosis, patients have elevated levels of galactomannan antigen, which is characteristic for infections caused by Aspergillus sp. [ 93 , 94 ].…”

Trichosporon inkin meningitis in Northeast Brazil: first case report and review of the literature

“…Trichosporon species are present in the environment and may belong to the human microbiota butmay associated with both superficial and deep infections [ 1 , 18 ]. Infections associated with CNS due Trichosporon are rare in immunocompromised patients and extremely rare in immunocompetent patients [ 20 ].…”

“…Several clinical conditions are considered to be risk factors for invasive trichosporonosis including the history of intensive chemotherapy, high dose of corticosteroids, burns, neutropenia, broad spectrum antibiotics usage and hematological malignancies [ 8 , 20 , 27 ]. In fact, the patient described in this study was previously immunocompetent but further submitted to long periods of corticosteroids and broad-spectrum antibiotics, besides suffering the invasive medical procedure to remove an acoustic neuroma.…”

Recurrent trichosporonosis with central nervous system involvement in an allogeneic hematopoietic stem cell transplant recipient

“…CNS trichosporonosis is uncommon in both the immunocompromised and the immunocompetent host. Reports of this condition in the literature are limited to case reports (5,(7)(8)(9). CNS trichosporonosis is usually fatal.…”