Disseminated mucocutaneous trichosporonosis in a patient with histiocytic sarcoma

Abstract

Trichosporon asahii is the causal agent of trichosporonosis. Patients with immunosuppression or hematological malignancies are at higher risk of infection. Skin and mucosal involvement appear as fast-growing papulonodular lesions and necrotic ulcers. Internal organ dissemination is lethal. Therapeutic success depends on the underlying disease. Here, the authors present the first case of disseminated mucocutaneous trichosporonosis in a patient with a post-mortem diagnosis of histiocytic sarcoma, a rare and aggressive haematolymphoid neoplasm. Regretfully, death occurred despite treatment with liposomal amphotericin B and supportive measures, showcasing the fatality of both diseases.

Keywords: Hematologic neoplasms; Histiocytic sarcoma; Trichosporon; Trichosporonosis; Ulcer.

Figure 1

Large, necrotic face ulcers affecting the cheek and the oral mucosa.

Figure 2

Face ulcer examinations. (A), Budding yeast cells and (B), PAS stained blastoconidia are observed on a Gram smear and on histopathology, respectively.

Figure 3

Face ulcer culture. (A), Trichosporon spp. colonies showed a raised, waxy appearance with radial furrows on Sabouraud culture. (B), Culture smear revealed hyphae, blastoconidia and arthroconidia with cotton blue stain.