Long-Term Azole Therapy After Subtotal Graft Removal for Trichosporon asahii Aortic Graft Infection

BACKGROUND: Trichosporonosis is a fatal opportunistic infection (mortality 30%-90%). Trichosporon aortic prosthetic graft infection has not been reported. CASE SUMMARY: A 55-year-old immunocompetent man developed Trichosporon asahii aortic graft infection 3 months after type A dissection repair, presenting with fever and peripheral emboli. At redo total arch replacement, the infected woven polyester graft was excised, but the expanded polytetrafluoroethylene stent graft was too deep in the descending aorta to remove and was retained after debridement. Long-term azole therapy achieved control without recurrence over 2 years. DISCUSSION: Diagnosis is difficult because culture-negative cases are not uncommon in prosthetic cardiovascular infection, and optimal management is undefined. The favorable outcome despite a retained expanded polytetrafluoroethylene segment may reflect its lower biofilm formation than woven polyester, though this remains speculative. TAKE-HOME MESSAGES: Consider T asahii in culture-negative graft infection. When explantation is unsafe, subtotal removal plus long-term azole therapy can be effective.