A Case of Fatal Invasive Trichosporonosis in the Setting of Immunosuppression and Post-COVID-19 Pneumonia

Trichosporon asahii is an opportunistic fungus that forms septate hyphae and pseudohyphae, resembling Candida albicans, and causes fungemia in susceptible individuals. Risk factors for T. asahii infection include immunosuppression, IV catheters, and malignancy. In the present case, a 67-year-old male with a history of renal transplant on immunosuppressive therapy was hospitalized for coronavirus disease 2019 (COVID-19) pneumonia. Despite treatment with steroids and broad initial antibiotic coverage with cefepime, doxycycline, and vancomycin, the patient underwent continual respiratory decline. His sputum culture on hospital day 10 was positive for non-candidal yeast, and despite subsequent appropriate empiric coverage with micafungin and amphotericin B, the patient continued to decline and ultimately died due to the resistance of T. asahii to these antifungals. This case highlights the importance of suspecting T. asahii as an infectious cause in patients whose cultures show non-candidal yeast and initiating appropriate antifungal treatment early in their treatment course.