Trichosporon inkin meningitis in Northeast Brazil: first case report and review of the literature

Abstract

Background: Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin.

Case presentation: Here we report the first clinical case of meningoencephalitis due to this species in a female previously healthy patient under corticosteroids and antibiotics therapy for several months. She was submitted to an invasive procedure to remove a left sided acoustic neuroma and further developed a cerebrospinal fistula. After some days of the procedure, she presented a predominantly and intensive occipital holocranial headache, followed by vomiting, hyporexia, weight loss, asthenia, irritability, difficulty to concentrate and rotator vertigo. The patient further developed a cerebrospinal fistula in the occipital region and was submitted to a surgical correction. After several months of clinical interventions, she was diagnosed with CNS Trichosporonosis, after Magnetic Resonance Imaging and positive microbiological cultures obtained within two different occasions (2 weeks apart). Despite the antifungal therapy with Amphotericin B and Voriconazole, the patient did not survive.

Conclusions: Despite CNS Fungal infections are mostly due to Cryptococcus spp., other emergent yeasts, such as T. inkin may be considered as a likely etiological agent. This is the first case report of CNS Trichosporonosis, where species identification was performed with rDNA sequencing.

Keywords: Antifungal susceptibility testing; Invasive Trichosporonosis; Meningoencephalitis; Northeast Brazil; Trichosporon inkin; Virulence factors.

Fig. 1

Axial Magnetic Resonance Imaging (MRI) at the posterior fossa level, showing extensive leptomeningeal enhancement near the anterior bulb contour and cerebellar folds (thin arrows). Heterogeneous material with enhancement near the pre-pontine cistern (thick arrow). Note the signs of surgical manipulation of the extra-cranial soft parts in the right occipital region (dashed arrow)

Fig. 2

a Cream-colored, dull, wrinkled cerebriform colonies, after 48 h of incubation at 30 °C on Sabouraud dextrose agar. b Colonies with typical “dirty” grey-blue color on CHROMagar Candida® medium after 72 h of incubation at 35 °C. c Micromorphological aspects after incubation in cornmeal agar containing Tween 80 for 72 h at 30 °C, showing long true hyphae e artroconidia. d Urease test of yeast cells grown in Cristensen’s urea Agar containing phenol red, showing positive results after incubation at 30 °C for 72 h