Invasive Trichosporon Mucoides Infection in a Uremic Patient with Type 2 Diabetes Mellitus on Maintenance Hemodialysis

Invasive Trichosporon mucoides infections are very rare in uremic patients. They are almost exclusively seen in immunocompromised patients, especially in the setting of neutropenic patients with hematologic malignancies. We report the case of a 62-year-old uremic woman, without neutropenia and on maintenance hemodialysis for four years, who developed nosocomial disseminated Trichosporonosis mucoides during a hospital admission for shortness of breath. The blood culture yielded Trichosporon mucoides, and amphotericin-B (0.5 mg/kg/day) was given with a successfully completed therapy in addition to the immediate removal of the Hickman catheter. However, sepsis recurred and pus culture from the stump of the left knee yielded T. mucoides. In addition to increasing the dosage of amphotericin B to 1 mg/kg/day, oral voriconazole 300 mg every 12 h were added, too. Stump revision was also performed and her condition improved thereafter. Disseminated trichosporonosis should be considered in the differential diagnosis of elderly uremic patients with diabetes, severe peripheral arterial occlusive disease and intravenous catheter, when sepsis does not improve after prolonged treatment with broadspectrum parenteral antibiotics. Removal of intravenous catheter, management for the infectious wound and aggressive anti-fungal agents are necessary for a successful Trichosporon mucoides treatment. (Acta Nephrologica 2011; 25: 30-32)