Karabay Oguz, Madariaga Miguel G, Kocoglu Esra, Ince Nevin, Kandirali Engin
Department of Clinical Microbiology and Infectious Diseases, Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.
Jpn J Infect Dis. 2006 Apr;59(2):129-31.
Trichosporon fungemia is usually seen in neutropenic patients with underlying hematological malignancies. In this report we describe a fatal case of Trichosporon asahii fungemia in a non-neutropenic patient with a non-hematological malignancy. For 1 week the patient exhibited hematuria, weakness, easy fatigability and headaches. At admission she had anemia, renal failure and evidence of right hydronephrosis and bladder wall masses as detected by CT scan. She did not have a history of tobacco abuse, contact with urinary carcinogens or Schistosoma infestation; her clinical picture was suggestive of bladder cancer. After some investigations the patient underwent radical cystectomy and ileal conduit surgery because of transitional cell carcinoma in the urinary bladder. After an initial uneventful improvement postoperatively the patient deteriorated and died of septic shock despite all reanimation efforts and antibiotherapy including fluconazole. The blood culture obtained 4 days before the patient died revealed T. asahii, which was isolated on the day she died and found to be resistant to fluconazole and caspofungin. This report suggests that clinicians remain aware that T. asahii fungemia may develop in clinically deteriorated patients even if they do not have a hematological malignancy.
毛孢子菌血症通常见于患有潜在血液系统恶性肿瘤的中性粒细胞减少患者。在本报告中，我们描述了一例非中性粒细胞减少的非血液系统恶性肿瘤患者发生的致命性阿萨希毛孢子菌血症病例。患者出现血尿、虚弱、易疲劳和头痛症状达1周。入院时，她有贫血、肾衰竭，CT扫描显示右肾积水和膀胱壁肿块。她没有吸烟史、接触尿路致癌物史或血吸虫感染史；其临床表现提示膀胱癌。经过一些检查后，患者因膀胱移行细胞癌接受了根治性膀胱切除术和回肠代膀胱术。术后最初情况平稳改善，但患者随后病情恶化，尽管采取了所有复苏措施并使用了包括氟康唑在内的抗生素治疗，仍死于感染性休克。患者死亡前4天采集的血培养显示有阿萨希毛孢子菌，在其死亡当天分离出该菌，发现其对氟康唑和卡泊芬净耐药。本报告提示临床医生应始终意识到，即使患者没有血液系统恶性肿瘤，在临床病情恶化的患者中也可能发生阿萨希毛孢子菌血症。
