Fatal case of severe fever with thrombocytopenia syndrome complicated by profound neutropenia and invasive trichosporonosis.
Kenichi Koga, Asami Yamada, Rie Furuta et al.
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Case in brief
A 71-year-old woman initially treated with corticosteroids and etoposide for clinically diagnosed hemophagocytic lymphohistiocytosis was transferred and diagnosed with severe fever with thrombocytopenia syndrome (SFTS); favipiravir was started. She developed profound neutropenia and respiratory failure requiring mechanical ventilation. Rising serum Aspergillus galactomannan levels prompted antifungal treatment for suspected invasive pulmonary aspergillosis, but blood cultures instead grew Cutaneotrichosporon dermatis, confirmed by molecular analysis. Despite antifungal therapy and intensive supportive care, she died of multiple organ failure.
What made this case unusual
The invasive fungal infection was C. dermatis trichosporonosis, identified in blood cultures after rising Aspergillus galactomannan had raised concern for pulmonary aspergillosis.
Diagnostic / clinical pearl
In SFTS complicated by profound neutropenia, remain alert to invasive fungal infection beyond aspergillosis; rising Aspergillus galactomannan did not identify the pathogen in this case.