Go Se Eun, Lee Kyung Jin, Kim Yaeni, Choi Jae Ki, Kim Yoo Jin, Lee Dong Gun
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Infect Chemother. 2018 Jun;50(2):138-143. doi: 10.3947/ic.2018.50.2.138.
Because primary antifungal prophylaxis is widely used for immunocompromised hosts, the incidences of unusual fungal infections have increased. Trichosporon asahii has emerged as an important life-threatening opportunistic systemic pathogen because of the increased use of cytotoxic or immunosuppressant agents, along with high mortality rates. Here, we describe a case of catheter-related T. asahii bloodstream infection with multiple septic skin nodules in both the arms and legs of the patient who was in the neutropenic period after allogeneic stem cell transplantation for myelodysplastic syndrome treated with prophylactic ciprofloxacin and itraconazole. We successfully treated her with intravenous voriconazole for more than a month without any complications. Clinicians should consider breakthrough Trichosporon infections when clinical progress in an immunocompromised patient with unexplained infection signs and symptoms does not improve despite proper treatment with antibiotics or various antifungal agents. In addition, voriconazole can be a good treatment choice for achieving better treatment results and prognosis.
由于原发性抗真菌预防广泛应用于免疫功能低下宿主，不常见真菌感染的发生率有所增加。随着细胞毒性或免疫抑制剂使用的增多以及高死亡率，阿萨希毛孢子菌已成为一种重要的危及生命的机会性系统性病原体。在此，我们描述了1例异基因造血干细胞移植治疗骨髓增生异常综合征后处于中性粒细胞减少期的患者，其发生了与导管相关的阿萨希毛孢子菌血流感染，双臂和双腿出现多个脓毒性皮肤结节，该患者接受了预防性环丙沙星和伊曲康唑治疗。我们用静脉注射伏立康唑成功治疗她1个多月，未出现任何并发症。当免疫功能低下患者尽管使用抗生素或各种抗真菌药物进行了适当治疗，但具有无法解释的感染体征和症状的临床进展仍未改善时，临床医生应考虑突破性毛孢子菌感染。此外，伏立康唑可能是获得更好治疗效果和预后的良好治疗选择。
