Invasive Trichoderma longibrachiatum breakthrough infection in a hematology patient

Trichoderma species are emerging as pathogens, causing invasive fungal infections, particularly in immunocompromised individuals. We report the case of a 61-year-old neutropenic female with hepatosplenic T-cell lymphoma and profound neutropenia, who developed a breakthrough infection with Trichoderma longibrachiatum while receiving liposomal amphotericin B for probable invasive pulmonary aspergillosis. Despite combination antifungal therapy the patient ultimately succumbed to multiple organ failure. Trichoderma longibrachiatum and Aspergillus fumigatus were identified as causative fungal pathogens. Antifungal susceptibility testing of the T. longibrachiatum isolate revealed resistance to isavuconazole but susceptibility to amphotericin B, voriconazole, itraconazole and olorofim.