Trichosporon inkin as an Emergent Pathogen in Patients With Severe Pemphigus

Area of Science:

• Medical Mycology
• Infectious Diseases
• Dermatology

Background:

• Pemphigus is a group of autoimmune blistering diseases affecting the skin and mucous membranes.
• Bloodstream infections (BSIs) are serious complications in immunocompromised patients.
• Trichosporon inkin is an emerging fungal pathogen with limited reported cases of invasive disease.

Observation:

• Two patients with pemphigus (one with pemphigus foliaceus, one with pemphigus vulgaris) developed bloodstream infections caused by Trichosporon inkin.
• One patient, an elderly male with pemphigus foliaceus, died despite treatment with liposomal amphotericin B.
• A young female with pemphigus vulgaris showed a positive response to voriconazole treatment.

Findings:

• One isolate of Trichosporon inkin exhibited a minimal inhibitory concentration of 2 mg/L for amphotericin B, indicating potential resistance.
• The study presents the first documented cases of bloodstream infections specifically by Trichosporon inkin in individuals with pemphigus.
• Treatment outcomes varied, with one patient succumbing to the infection while another responded to an alternative antifungal agent.

Implications:

• Delayed diagnosis and suspicion of invasive Trichosporon inkin infection can lead to adverse outcomes in severe pemphigus cases.
• This opportunistic fungal infection appears to be highly resistant to conventional and potent antifungal treatments, necessitating further research into effective therapeutic strategies.
• The findings underscore the importance of considering rare fungal pathogens in the differential diagnosis of febrile episodes in pemphigus patients, particularly those refractory to standard treatments.