Trichosporon mucoides fungemia in a liver transplant recipient: case report and review

Abstract

Four months after receiving an orthotopic liver transplant, a 51-year-old man was admitted for progressive liver failure and severe hepatocellular necrosis thought to be due to tacrolimus. During his hospitalization he experienced bloodstream infections including fungemia due to Trichosporon mucoides and prolonged undulating fever despite antifungal and antibacterial treatment. He underwent removal of the allograft and implantation of another liver. Fever continued postoperatively until therapy with posaconazole was initiated. Initiation of posaconazole led to clinical improvement until the patient's demise from bacteremic vancomycin-resistant enterococcal peritonitis. Trichosporonosis appears to be an emerging fungal infection among immunocompromised individuals (including both hematological and solid organ transplant recipients). T. mucoides is a rare cause of systemic infection. When it occurs, trichosporonosis usually is associated with hematological malignancies and, to the best of our knowledge, has not been previously reported in a liver transplant recipient. The optimal treatment is not well defined. We report here the first case using posaconazole for treatment of trichosporonosis in a liver transplant recipient caused by T. mucoides.

Emerging Fungal Infections in Solid Organ Transplant Recipients

“…Trichosporon species, particularly T. asahii and T. mucoides can cause systemic infection in SOT recipients (74, 75). These yeasts are found in diverse setting including soil, water, and vegetables and as commensals of the human skin and GI tract.…”

Oral colonization by yeasts in HIV-positive patients in Brazil

“…predominantly cause superficial skin infections and scalp or pubic white piedra, but they can also cause invasive disease in immunocompromised individuals. Trichosporonosis, the deep-seated infection caused by this fungus, is an often fatal disease with a mortality rate of 80% 16,28,36 .…”

Rare Case of Trichosporon mucoides Skin Infection in an Immuno-competent Patient

“…T. mucoides is a more frequent cause of infections like onychomycosis as compared to other Trichosporon species according to studies carried out by The´ rizol-Ferly et al (The´ rizol-Ferly et al, 1994;The´ rizol-Ferly et al b, 1994). Trichosporon mucoides has been reported from several cases of kidney, heart and liver transplant recipients (Nettles et al, 2003, Lacasse andCleveland, 2009), premature newborns with deep infections (Go¨kahmetog˘lu et al, 2002;Silva et al, 2004), peritoneal dialysis patients (Chen et al, 2013), leukemic (Kendirli et al, 2006) and diabetics (The´ rizol-Ferly et al, 1994).…”