Trichosporon inkin subcutaneous infection in a rheumatoid arthritis patient

Abstract

A 74-year-old woman presented with painful ulcerative nodules on the left forearm. She had received systemic steroid therapy for rheumatoid arthritis for several years. On physical examination, there were four hemorrhagic ulcerative nodules with a linear distribution on the left forearm (Fig. 1A). These nodules had developed over the course of 2 months, and the number of lesions had increased despite systemic antibiotic therapy. There was no sign of systemic dissemination of the disease. Biopsy of a nodule demonstrated suppurative granulomatous infiltration (Fig. 1B); the hyphae stained positive with periodic acid-Schiff (data is not shown) and Gomori-methenamine silver stains in the dermis (Fig. 1C). The biopsy specimen was cultured in Sabouraud's dextrose agar supplemented with cycloheximide with incubation at 26 degrees C. A yeast-like creamy colony grew in 1 week. The colony became yellowish gray in color and the surface folded radially after 4 weeks of incubation (Fig. 2A). Microscopic examination revealed arthroconidia and blastoconidia (Fig. 2B), and urease activity was positive. The fungus was identified as Trichosporon beigelii by yeast biochemical card (YBC, Biomerieux Vitek, Inc., Hazelwood, MO, USA). The sequences of rDNA obtained from the colony were amplified using polymerase chain reaction (PCR) primer, analyzing the sequences of the 5.8S and 28S rDNA regions for the genetic identification of the Trichosporon species. The sequences of the PCR product matched the corresponding sequences of the T. inkin strain with 99% accuracy (Fig. 2C). The patient was given oral itraconazole for 8 weeks with good clinical results.

Molecular Identification and Susceptibility ofTrichosporonSpecies Isolated from Clinical Specimens in Qatar: Isolation ofTrichosporon dohaenseTaj-Aldeen, Meis & Boekhout sp. nov

“…Trichosporon has also been reported to cause fungemia (5,9,25,29,30,33,53,62). Members of the genus Trichosporon have occasionally been implicated as nail pathogens (16,28,74) and in subcutaneous infections (66). Trichosporon is considered an opportunistic agent, and therefore, recovery of Trichosporon species capable of growing at 37°C, especially from immunocompromised patients, should be regarded as potentially significant.…”

Disseminated Trichosporon inkin and Histoplasma capsulatum in a patient with newly diagnosed AIDS

“…5,9 Other predisposing factors include AIDS, heart valve surgery, corticosteroid treatment, extensive burns, and surgical wounds. 8 Although AIDS is described as a risk factor for disseminated trichosporonosis, to our knowledge no cases of trichosporonosis in patients with diagnosed AIDS have been reported. In addition, we were unable to find any other reports of simultaneous disseminated T inkin and H capsulatum in any patient, immunocompromised or healthy.…”

“…6 In immunodeficient hosts, Trichosporon is capable of causing both superficial and invasive infection. 8,9 Compared with disseminated histoplasmosis, reports of disseminated Trichosporon are relatively uncommon. Patients with neutropenia are particularly susceptible.…”

“…Empirical antibiotic therapy is believed to enhance mucosal colonization. 8 Seeding may occur with insertion of vascular catheters or chemotherapy-induced epithelial damage. 7,8 Infection may be localized to a single organ via direct seeding.…”

“…8 Seeding may occur with insertion of vascular catheters or chemotherapy-induced epithelial damage. 7,8 Infection may be localized to a single organ via direct seeding. Invasive trichosporonosis has reportedly caused endocarditis, pneumonia, lung abscess, and peritonitis associated with peritoneal dialysis.…”