Disseminated Trichosporon asahii infection in a combined liver-kidney transplant recipient successfully treated with voriconazole

Abstract

Introduction: Trichosporon asahii is an emerging cause of systemic fungal infection in an immunocompromised host. Several life threatening disseminated T. asahii infection in single solid organ (liver or kidney) transplant recipients, in neutropenic and hematological malignancy patients have been reported.

Case presentation (methods and results): A 49-year old gentleman who underwent simultaneous living-donor liver transplantation (donor sister) and kidney transplant (donor wife) developed fever and subsegmental patchy consolidation with right sided pleural effusion on fourth postoperative day. Central line blood stream infection was suspected. Blood culture grew creamy white colonies of T. asahii on blood agar with characteristic dirty-green colonies on CHROMagar. Laboratory analysis of pleural fluid also revealed budding yeast cells identified as T. asahii. Microscopy of the isolates showed hyphae, arthroconidia, and blastospores. The isolates were identified as T. asahii by VITEK MS which uses matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Initially liposomal amphotericin B and micafungin was initiated, but due to lack of clinical and microbiological response, patient was switched to voriconazole. Simultaneously, tacrolimus doses were reduced to one-third in view of interaction with voriconazole. Subsequently, patient improved with resolution of fever and microbiological cure.

Conclusion: This is the first case report of disseminated T. asahii infection in a combined liver-kidney transplant recipient successfully treated with voriconazole. Azole antifungal are the promising drug of choice for systemic T. asahii infection. Drug interactions should be considered while using these antifungal agents.

Keywords: Trichosporon asahii; combined liver-kidney transplant; immunocompromised hosts; transplant recipient; voriconazole.

Figure 1

Characteristics dirty‐green colonies of T. asahii on CHROMagar

Figure 2

A, Hyphae, pseudohyphae, arthroconidia, and blastospores of T. asahii on wet mount preparation in x1000 magnification. B, Arthroconidia of T. asahii on wet mount preparation in x1000 magnification. C, Gram stain showing hyphae, pseudohyphae, arthroconidia and blastospores of T. asahii in x1000 magnification. D, Gram stain showing arthroconidia of T. asahii in x1000 magnification