Disseminated, fatal Trichosporon asahii infection in a bone marrow transplant recipient.

Trichosporon asahii is the most important species regularly isolated from systemic mycoses and shows a predilection for hematogenous dissemination. This report describes the first fatal case of disseminated trichosporonosis caused by T. asahii in a patient with familial aplastic anemia (AA). An 11-year-old girl with familial AA received chemoradiotherapy and immunosuppressive therapy for bone marrow transplantation. She was neutropenic and suffered from fever, cough, and severe mouth ulcers. T. asahii was repeatedly demonstrated by appropriate morphological and physiological characteristics, i.e., arthroconidium formation, urease activity, and assimilation of carbon and nitrogen compounds. T. asahii was found in samples of sputum, nose, and mouth ulcers by direct microscopy and culturing. Furthermore, postmortem histopathology study revealed vast tissue invasion of fungal hyphae characteristic of Trichosporon in the lung and liver. Disseminated trichosporonosis should be suspected in immunocompromised patients when a febrile condition does not improve after prolonged treatment with broad-spectrum parenteral antibiotics.