Department of Dermatology, Kawasaki Municipal Hospital.
Department of Hematology, Kawasaki Municipal Hospital.
Med Mycol J. 2024;65(1):17-21. doi: 10.3314/mmj.23-00009.
Disseminated trichosporonosis is a rare fungal infection whose risk factors are hematological malignancies and neutropenia. Recently, breakthrough Trichosporon infections after administration of micafungin, the first-line systemic antifungal agent in compromised hosts, have been widely recognized. A man in his seventies about 1 month into chemotherapy for acute megakaryoblastic leukemia presented with a worsening fever and dyspnea. The patient was being administered with empirical micafungin therapy for suspected candidiasis. As the symptoms progressed, scattered erythema appeared on the trunk, some with a dark red vesicle at the center. Blood cultures identified Trichosporon asahii, as did the specimen of the skin biopsy. On the basis also of the presence of pneumonia on chest computed tomography, we confirmed the diagnosis of disseminated trichosporonosis and changed the antifungal agent from micafungin to voriconazole. Blood culture turned out to be negative 1 month after administrating voriconazole. However, the patient died of the leukemia. Our review of previous reports on cutaneous manifestations of disseminated trichosporonosis revealed that despite their morphological diversity, erythema with a red papule or vesicle at the center, implying necrosis, was also observed in previous cases. Our case report suggests that dermatologists should be aware of skin manifestations of disseminated trichosporonosis after micafungin administration, especially in cases of hematological malignancies.
播散性毛孢子菌病是一种罕见的真菌感染，其危险因素是血液系统恶性肿瘤和中性粒细胞减少症。最近，在使用米卡芬净（受损害宿主中一线全身抗真菌药物）后，毛孢子菌感染的突破已得到广泛认可。一位 70 多岁的男性，在接受急性巨核细胞白血病化疗约 1 个月后，出现发热和呼吸困难加重。该患者因疑似念珠菌病正在接受经验性米卡芬净治疗。随着症状的进展，躯干上出现了散在的红斑，有些红斑中心有暗红色水疱。血培养鉴定为阿萨希毛孢子菌，皮肤活检标本也是如此。此外，胸部计算机断层扫描显示存在肺炎，我们确诊为播散性毛孢子菌病，并将抗真菌药物从米卡芬净改为伏立康唑。伏立康唑给药 1 个月后血培养结果转为阴性。然而，患者因白血病去世。我们对播散性毛孢子菌病皮肤表现的既往报告进行了回顾，结果表明，尽管其形态多样性，但在既往病例中也观察到了中心有红色丘疹或水疱的红斑，提示坏死。我们的病例报告提示皮肤科医生应注意米卡芬净给药后播散性毛孢子菌病的皮肤表现，尤其是在血液系统恶性肿瘤患者中。
