Fatal invasive trichosporonosis in a Filipino AIDS patient
E. Roxas1, M.A. Penamora1, A. Bello1, K. Leyritana1, A.D. Roman1, P. Pontejos2, E.M. Salvana1,3, M. Saniel1,4
1University of the Philippines-Philippine General Hospital, Medicine, Section of Infectious Diseases, Manila, Philippines, 2University of the Philippines-Philippine General Hospital, Medicine, Section of Dermatology, Manila, Philippines, 3University of the Philippines, National Institute of health, Manila, Philippines, 4The Medical City, Infectious Disease Practice and Innovations, Pasig, Philippines
Background: Disseminated Trichosporon infection is a rare, life-threatening infection in immunocompromised patients. It has been reported as an emerging opportunistic infection in those with Acquired Immune Deficiency Syndrome (AIDS). Only eight cases of disseminated trichosporonosis in patients with HIV have been documented, none in Southeast Asia.
Methods: A case report.
Results: A 28-year-old Filipino male presented with flesh-colored papules on the face and neck, eventually progressing into hemorrhagic crusts which ulcerated over the course of two months (Figure 1). He was diagnosed with HIV in 2006, but did not start antiretrovirals and was lost to follow-up until 2009 when he was confined with Pneumocysitis pneumonia. At that time, his CD4 count was 3 cells/µL.
He was treated as disseminated cryptococcosis due to the presence of yeast cells on skin biopsy. Serum cryptococcal latex agglutination test (CALAS) was reactive at 1:8. CSF CALAS was negative. Despite antifungal therapy with amphotericin, fluconazole and itraconazole, the patient progressively deteriorated and expired.
After eight weeks of incubation, two weeks after the patient died, sputum and skin tissue cultures grew Trichosporon sp.
Conclusion: We present the first disseminated Trichosporon infection in a Filipino AIDS patient. It can mimic cryptococcosis and yield a false-positive CALAS. Appropriate treatment depends on a high level of suspicion; prognosis remains poor.
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