Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient

Trichosporon asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease but developed an ultimately lethal T. asahii systemic infection. There is a strong possibility that our patient had been colonized at the site infection as part of the normal skin flora. After a period of one month bed rest due to an accidental fall and fracture of the right shoulder-blade, a 61-year old woman experienced severe oedema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphoedema. Samples collected from affected areas revealed T. asahii and the patient was referred to a hospital for infection diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted in our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the outcome. Nowadays physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.