[A case of rheumatoid arthritis involving disseminated torichosporonosis]

Area of Science:

• Medical Mycology
• Infectious Diseases
• Rheumatology

Background:

• Immunosuppressive therapy for rheumatoid arthritis (RA) involving methotrexate and corticosteroids can predispose patients to opportunistic infections.
• Organizing pneumonia and aspiration pneumonia are serious pulmonary complications that can occur in immunocompromised individuals.

Observation:

• A 75-year-old male with RA on long-term immunosuppression developed disseminated trichosporonosis following treatment for pneumonia and a lumbar compression fracture.
• Despite broad-spectrum antibiotics, antifungals (micafungin), and pulsed steroids, the patient experienced acute respiratory failure.
• Trichosporon asahii was identified post-mortem in blood and urine cultures, confirming disseminated trichosporonosis.

Findings:

• The patient presented with numerous risk factors for trichosporonosis, including prolonged corticosteroid use leading to neutrophilic dysfunction, broad-spectrum antibiotic and antifungal administration, and central venous catheterization.
• Diagnosis was supported by positive blood cultures, elevated serum glucuronoxylomannan antigen and beta-D glucan levels, and lack of clinical improvement.
• This case represents a rare instance of disseminated trichosporonosis without a primary hematological disorder.

Implications:

• Disseminated trichosporonosis, though typically a hematological infection, can manifest in non-hematological conditions in immunocompromised patients.
• Early recognition and prompt management of invasive fungal infections are crucial in patients with significant immunosuppression.
• This case underscores the importance of considering rare fungal pathogens in refractory or progressive infections among patients with multiple risk factors.