Successful Treatment of Trichosporon asahii Fungemia with Fluconazole in a Non-neutropenic Patient with Lung Cancer
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Invasive trichosporonosis is rare, but frequently fatal. Trichosporon asahii fungemia usually occurs in neutropenic hematologic malignant patients, patients with HIV infection, organ transplant recipients, and recipients of prosthetic heart valves. In this report we describe a 69-year-old man case of Trichosporon asahii fungemia in a non-neutropenic patient with lung cancer. He was diagnosed as nonsmall cell lung cancer on March 2010. He received concurrent chemoradiation therapy until May 2010 and consolidation chemotherapy on June 2010. One week after the last chemotherapy, he was adimitted to intensive care unit with acute respiratory failure. A chest CT revealed diffuse ground glass opacities and consolidation in mainly right lung. Bronchoalveolar lavage was not performed because of neutropenic fever and hypoxemia. After a week of neutropenic state, WBC count was recovered. Since admission, he was treated with intravenous piperacillin-tazobactam for about three weeks. He was also treated with bactrim for suspected Pneumocystis jirovecii for two weeks, even though the organism was not proved microbiologically. Seven days after stopping piperacillin-tazobactam, he developed fever without change of chest image. Because of pyuria on urinalysis, he was retreated with intravenous piperacillin-tazobactam for urinary tract infection. Three days later, two blood cultures yielded Trichosporon asahii, and urine culture yielded Candida albicans. Therefore, fluconazole was added empirically and maintained for three weeks. He responded to the fluconazole and has been stable since then. Our case in this report was non-neutropenic patient with lung cancer, and had not central venous catheter. However, he received broad-spectrum antibiotics. In one report, most invasive trichosporosis was associated with prior antibiotic therapy, use of a central catheter, malignancy, and ICU admission. In some reports, Azoles had good in vitro activity, whereas amphotericin B and echinocandins were not active against Trichosporon isolates. Although an optimal therapy for trichosporonosis has yet to be identified, our observations in this case provide the usefulness of fluconazole in a non-neutropenic patients with solid tumor.
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