Breakthrough Trichosporon asahii infection in a patient with acute myeloid leukemia receiving micafungin

Micafungin is a recently approved echinocandin with broad spectrum activity against Candida and Aspergillus species. However, this agent has limited activity against a number of fungi, including Trichosporon. We report a case of Trichosporon asahii fungemia in a 65 year old woman with acute myeloid leukemia that developed after 10 days of empirical micafungin therapy. Trichosporonosis was successfully treated with voriconazole and she achieved complete hematologic remission. After consolidation therapy, T. ashaii fungemia redeveloped, despite empirical amphotericin therapy for neutropenic fever. This was also controlled successfully with voriconazole. Because the use of micafungin is expected to increase, due to its effective antifungal activity, the possibility of breakthrough trichosporonosis should be considered in patients receiving micafungin. Voriconazole may be effective in controlling disseminated T. ashaii infection in neutropenic patients. (Korean J Med 77:S1318-S1322, 2009) 서 론