A 75-year-old man who developed
disseminated trichosporonosis had a long history of immunosuppressive therapy with weekly
methotrexate and low-dose
prednisolone for
rheumatoid arthritis (RA). He had been administered 30 mg of
prednisolone per day for
organizing pneumonia, probably due to the RA, for about 3 months before admission for a lumbar
compression fracture. He then developed bilateral
aspiration pneumonia with
pleural effusion, treated successfully with broad-spectrum
antibiotics meropenem and
ciprofloxacin, and fluid management. He then developed acute, progressive
respiratory failure with changes in both lung lobes in chest computed tomography (CT).
Meropenem,
ciprofloxacin,
micafungin, and pulsed
steroid administration were ineffective. He died of
respiratory failure, after which Trichosporon asahii was first detected in blood and urine culture.
Disseminated trichosporonosis was determined based on positive blood culture, elevated serum
glucuronoxylomannan antigen and beta-
D glucan, and the man's lack of clinical progress. He had numerous risk factors for
trichosporonosis, including neutrophilic dysfunction due to prolonged
steroid therapy, administration of broad-spectrum
antibiotics and
micafungin, and central venous catheterization.
Disseminated trichosporonosis is a chiefly hematological
infection and case reports without hematological disorders are rare, so we report this instructive case.