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• W3205957381 abstract "TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Trichosporon asahii is a fungal species that is ubiquitous in nature is increasingly being recognized as a life-threatening pathogen that has no effective antifungal therapy. We present a unique case of Trichosporon Asahii and Mycobacterium Kansasii necrotizing pneumonia with pulmonary abscesses and empyema. CASE PRESENTATION: Patient is a 64-year-old female with a past medical history of diabetes, hypertension and multiple strokes who presented with left sided weakness and dysarthria that started 7 hours prior to arrival. She was found to be in Afib with RVR, scoring 1 point on the NIH stroke scale. During her evaluation, she became acutely dyspneic and hypoxic, requiring intubation for acute hypoxic respiratory failure. A Computed Tomography of the brain revealed multiple acute ischemic infarcts and chronic infarcts. Her initial chest CT on admission showed multifocal pneumonia with left upper lobe cavitation and significant upper lobe predominant emphysema with bullae likely related to her long-standing smoking history. Acid fast bacilli culture revealed Mycobacterium Kansasii and the patient was treated with Rifampin, Ethambutol, and Isoniazid. She had a complicated hospital course, including AKI with ATN, requiring hemodialysis and a tracheostomy for airway protection and a percutaneous endoscopic gastrostomy for her nutritional requirements. She was in septic shock and was placed on broad spectrum antibiotics, vasopressors and stress-dose steroids. Multiple cultures were sent, including urine, blood, sputum and a BAL sample. Repeat CT showed LUL necrotizing pneumonia with pulmonary abscesses and empyema. One month after positive Mycobacterium culture, the patient's sputum culture grew Trichosporon Asahii and she was started on voriconazole. Later during the hospital course, she entered PEA arrest and was seen with copious blood from endotracheal tube and ultimately expired. DISCUSSION: While usually linked to superficial skin infections, Trichosporon species can be opportunistic pathogens that can cause hemorrhagic and necrotizing bronchopneumonia as a result of vascular invasion. Risk factors for invasive Trichosporon infections include immunosuppression, malignancy, central catheterization, prior antibiotic therapy, and intensive care unit admission. Studies suggest that voriconazole is the drug of choice in treatment, however, this recommendation relies primarily on in vitro susceptibility testing and limited case reports. Our case represents the first case of Trichosporon asahii infection with concurrent respiratory bacterial infection with Mycobacterium kansasii. CONCLUSIONS: With increasing cases of opportunistic Trichosporon infections documented in the literature, clinicians must be aware of the organism's clinical presentation, risk factors that enhance colonization, and appropriate therapies. Further studies need to be conducted to determine the optimal medical therapy. REFERENCE #1: Ebright JR, Fairfax MR, Vazquez JA. Trichosporon asahii, a non-Candida yeast that caused fatal septic shock in a patient without cancer or neutropenia. Clin Infect Dis. 2001 Sep 1;33(5):E28-30. doi: 10.1086/322640. Epub 2001 Jul 26. PMID: 11477533. REFERENCE #2: Afsari A, Zhou J, Hassan M, Naab T, Hemorrhagic Necrotizing Pneumonia Caused by Trichosporon asahii Suspected by Distinctive Histology in Tissue, American Journal of Clinical Pathology, Volume 152, Issue Supplement_1, October 2019, Pages S46–S47, https://doi.org/10.1093/ajcp/aqz113.023 REFERENCE #3: Li H, Guo M, Wang C, Li Y, Fernandez AM, Ferraro TN, Yang R, Chen Y. Epidemiological study of Trichosporon asahii infections over the past 23 years. Epidemiol Infect. 2020 Jul 24;148:e169. doi: 10.1017/S0950268820001624. PMID: 32703332; PMCID: PMC7439294. DISCLOSURES: No relevant relationships by Benjamin Carmel, source=Web Response No relevant relationships by Mauricio Danckers, source=Web Response No relevant relationships by Daniel Heller, source=Web Response No relevant relationships by Anamika Neralla, source=Web Response No relevant relationships by Vijay Srinivasan, source=Web Response" @default.
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• W3205957381 date "2021-10-01" @default.
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• W3205957381 title "AN UNUSUAL CASE OF TRICHOSPORON ASAHII PNEUMONIA" @default.
• W3205957381 doi "https://doi.org/10.1016/j.chest.2021.07.486" @default.
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