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Trichosporon asahii causing subcutaneous mycoses in an immunocompetent patient: case report and a minireview
Wdson Luis Lima Kruschewsky1, Pedro Massaroni-Peçanha2, Simone Bravim Maifrede3
1Hospital Universitário Cassiano Antônio de Moraes (HUCAM), Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil.
Abstract:
Trichosporon spp. are a constituent of the normal flora of humans that can cause both superficial and invasive infections, mainly in immunocompromised and immunocompetent hosts, respectively. Herein, we a report of Trichosporon asahii causing subcutaneous fungal infection (SFI) in an immunocompetent patient after carpal tunnel surgery. Although susceptible to fluconazole, the treatment of SFI failed even using high doses of this azole. The skin lesion improved following the administration of voriconazole. We conducted a literature minireview searching reports on SFI in immunocompetent patients to check for epidemiological, diagnostic, therapeutic, and outcome characteristics. A total of 32 cases were reported. Despite being uncommon, the clinical suspicion and early diagnosis of SFI in immunocompetent patients undergoing previous surgery are important. Our study indicated that the azoles are the most active antifungal agents against Trichosporon spp., except for fluconazole, and voriconazole can be considered the first therapeutic option.
Insights
Trichosporon asahii can cause subcutaneous fungal infections (SFI) in immunocompetent individuals post-surgery. Voriconazole is recommended as a first-line treatment option for SFI caused by Trichosporon spp.
Area of Science:
- Mycology
- Infectious Diseases
- Dermatology
Background:
- Trichosporon spp. are common human commensals with the potential to cause superficial and invasive infections.
- Subcutaneous fungal infections (SFI) are rare, particularly in immunocompetent individuals.
Observation:
- A case of Trichosporon asahii causing SFI in an immunocompetent patient post-carpal tunnel surgery is reported.
- Initial treatment with high-dose fluconazole was ineffective despite in vitro susceptibility.
Findings:
- Voriconazole administration led to improvement of the skin lesion.
- A literature review of 32 cases of SFI in immunocompetent patients highlighted epidemiological, diagnostic, therapeutic, and outcome characteristics.
- Azoles demonstrate activity against Trichosporon spp., with fluconazole showing limited efficacy.
Implications:
- Early clinical suspicion and diagnosis of SFI are crucial in immunocompetent patients, especially after surgery.
- Voriconazole is suggested as a primary therapeutic choice for Trichosporon-induced SFI.
- This study contributes to understanding SFI management in immunocompetent hosts.
