Rhinocerebral Mucormycosis and Trichosporon asahii Fungemia in a patient with acute lymphoblastic leukemia: A rare co-infection and literature review

Abstract Background We report one rare case of concomitant rhinocerebral mucormycosis and Trichosporon asahii (T. asahi) Fungemia secondary to Pseudomonas aeruginosa bloodstream infection(BSI) in a neutropenic patient with acute lymphoblastic leukemia. A review of the literature is included. Case presentation: A 1-year-old baby was diagnosed with B-line acute lymphoblastic leukemia and received regular chemotherapy which was admitted to hospital for vomiting, diarrhea, low fever and poor mental reaction. Carbapenem resistant- Pseudomonas aeruginosa was isolated via blood culture, and ceftazidime/ averbactam was administrated. The patient presented with necrotizing lesion on the right side of the nasal alar and the right corner of the eye. Later, necrosis rapidly expanded to almost his entire face on the 8th day, Rhizopus delemar and T. asahi was isolated from necrotic tissue. T. asahi was further recovered via blood culture. The anti-infection protocol was changed to treatment of Pseudomonas aeruginosa BSI with ceftazidime/ averbactam, amphotericin B cholesterol sulfate and voriconazole was administrated for Rhizopus delemar and T. asahi. Unfortunately, He deteriorated and died for multiple organ failure and rapid progress of infection. Conclusions For acute lymphoblastic leukemia patients, by maintaining a high level of clinical suspicion, promptly starting antifungal treatment, aggressively removing necrotic tissue through surgery, and addressing the underlying immunosuppression, it may be possible to decrease mortality rates.