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Abstract: Invasive fungal infections pose significant challenges in the management of immunocompromised patients, particularly those undergoing treatment for hematologic malignancies. Trichosporon asahii is a rare but severe cause of invasive trichosporonosis, associated with mortality rates. Effective management is complicated by its resistance to echinocandins and reduced susceptibility to polyenes, necessitating azole-based therapy. This paper aims to illustrate the diagnostic challenges associated with Trichosporon infections, analyze the complexities of treatment, review and synthesize known risk factors, and highlight the need for improved clinical management. It addresses the clinical and therapeutic difficulties involved in diagnosing and treating Trichosporon asahii infections in pediatric and adult hemato-oncologic patients. We present the first case of a 14-year-old female with T-cell acute lymphoblastic leukemia who developed a disseminated Trichosporon asahii infection during chemotherapy in Central and Eastern Europe. Initial symptoms included joint pain, fever, and neutropenia. The diagnosis was confirmed through synovial fluid and urine cultures. Despite initial treatment with voriconazole (70 days) and liposomal amphotericin B (309 days), the infection progressed, involving the lungs, liver, kidneys, and spleen. The patient transitioned to isavuconazole (232 days intravenous then orally), along with extensive supportive care, which eventually controlled the infection. However, the patient experienced significant complications, including joint contractures and prolonged hospitalization. Maintenance therapy was carefully adjusted to minimize adverse effects while ensuring disease control. The patient was followed monthly through September 2024, resulting in a successful outcome. A literature review highlighted neutropenia, antibiotic use, central venous catheters, and corticosteroid therapy as significant risk factors for invasive trichosporonosis. The diagnostic challenge stems from its resemblance to Candida and other yeasts, necessitating advanced methods like matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for accurate identification. Voriconazole remains the first-line treatment, with combination therapy using liposomal amphotericin B as a salvage approach. This case underscores the critical importance of early recognition and targeted management of Trichosporon infections in immunocompromised patients. Enhanced diagnostic techniques and tailored antifungal strategies are imperative to improve outcomes. This case provides new insight for pediatric hematology practice by demonstrating that early use of advanced diagnostic methods and timely adjustment to azole-focused antifungal therapy are critical for controlling disseminated Trichosporon asahii infections, even in severely immunocompromised children. Keywords: invasive fungal infections, precursor T-cell acute lymphoblastic leukemia, trichosporon asachii, trichosporonosis, isavocunazole, antifungal therapy
Mozga et al. (Mon,) studied this question.