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Pneumonia caused by Trichosporon pullulans in an autologous peripheral blood stem cell transplant recipient: possible misidentification

Bone Marrow Transplantation volume 35, pages 1219–1220 (2005)Cite this article

Trichosporon pullulans infections are very rare and potentially fatal in patients with haematological malignancies and in bone marrow transplant recipients. Biochemical systems may present certain limitations for accurate identification of these new and uncommon yeast isolates. Our experience suggests that clinical features, radiological signs and proinflammatory markers including C-reactive protein, fibrinogen, and procalcitonin remain the mainstay for monitoring the efficacy of antifungal treatment in the presence of new and rare pathogen agents.

The Trichosporon species, emerging opportunistic agents, are well recognized as pathogens capable of causing systemic disease. Most of these infections, occurring in immunocompromised patients, are described in association with T. beigelii. T. pullulans is rarely reported as a fungal pathogen. Biochemical testing may prove difficult when used to identify these new and unusual organisms. We report a 67-year-old man who underwent a second autologous peripheral blood stem cell transplant (PBSCT) for light-chain multiple myeloma. He was conditioned with melphalan 140 mg/m2; on day 0, he received cryopreserved PBSC (3.2 × 106 CD34+ cells/kg). Engraftment was prompt, neutrophil recovery >0.5 × 109/l and platelets >20 × 109/l occurring on days +11 and +12, respectively. Surveillance cultures were periodically performed from nasal, pharyngeal, rectal, urinary and skin swabs. He received antibacterial prophylaxis with ciprofloxacin (500 mg twice a day) and antifungal prophylaxis with fluconazole (100 mg orally once a day) starting from day −3. He became febrile from day +7. Chest X-ray was clear. Blood cultures, performed every 8 h and during each febrile episode, were negative. He was treated empirically with broad-spectrum antibiotics. Subsequent modifications to treatment were dictated by clinical and radiological signs and microbiological results. On day +9, a chest X-ray showed a single, faint, nonspecific nodular infiltrate in the left lower lobe, accompanied by persistent fever and modest dyspnoea. Cephalosporin was substituted for carbapenem, and intravenous voriconazole was commenced because of its tolerability and demonstrated superiority to conventional amphotericin against aspergillosis.1 On day +12, a chest X-ray revealed multiple circumscribed nodular infiltrates; computed axial tomography showed mass-like infiltrates with no surrounding halo or ground-glass attenuation. Arterial blood gases showed marked hypoxia; the patient received 100% oxygen by mask at 6–12 l/min. Antifungal therapy was changed from voriconazole to intravenous caspofungin at a dose of 70 mg on day 1 and 50 mg subsequently; caspofungin was used because of its good tolerance and the fact that it has been shown to be effective as salvage treatment for invasive aspergillosis in patients refractory to other antifungal drugs,2 and as primary treatment for invasive candidiasis.3 It has also been used empirically in persistently febrile neutropenic patients.4

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  1. Hematology/Oncology Unit, CROB Regional Hospital, Rionero in Vulture, Potenza, Italy

    G Mele, M Musci, C Musto, L D'Amato, A Traficante & N Di Renzo

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Mele, G., Musci, M., Musto, C. et al. Pneumonia caused by Trichosporon pullulans in an autologous peripheral blood stem cell transplant recipient: possible misidentification. Bone Marrow Transplant 35, 1219–1220 (2005). https://doi.org/10.1038/sj.bmt.1704987

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