关键词: 毛孢子菌病, 毛孢子菌属, 真菌血症

Abstract: Objective To report a case of disseminated digestive tract and skin infection by Trichosporon asahii. Methods The patient′s medical history, with the course of diagnosis and treatment at many hospitals over the past two years, was reviewed. Necrotic tissues were obtained from the ulcers at var- ious body sites for direct microscopic examination, culture and histopathological examination. Fungus culture was performed with blood, urine, and stool samples. Antifungal susceptibility testing of the isolate was done in vitro . The sequence of rDNA ITS of the fungal isolate was tested. Type-B ultrasonic diagnosis, nuclear magnetic resonance for liver and gall, and endoscopic retrograde cholangiopan creatography （ERCP） were also performed. Sufficient antifungal agents were combined and applied timely for this patient systemically and topically. Results Pathological examination showed lumping spores, few hyphae, arthroconidia and blastospores in the necrotic tissues. As shown by direct microscopy of sheeting of necrotic tissues, there were abundant hyphae, tubby arthroconidia and blastospores. The culture of blood and many ulcer tissues was positive for the growth of Trichosporon asahii, which was proved to be sensitive to fluconazole and amphotericin B. Gene sequencing confirmed that the isolate was Trichosporon asahii. Abundant hyphae and arthroconidia were also found in the infectious granulomas of duodenum mamilla. Furthermore, angiocholitis of inner and outer liver, chronic pancreatitis and duodenal papillitis were detected by the above imaging examinations. A diagnosis of Trichosporon asahii fungemia-disseminated trichosporonosis was made. The patient was greatly improved by the combined treatment with fluconazole and amphotericin B followed by itraconazole. Conclusions Deep mycosis should be suspected in patients with a condition which could not be controlled or even exacerbated by the strategies of anti-tuberculosis, anti-sarcoidosis, etc. Antifungal agents should be applied sufficiently and early, and gradually decrease in dosage with disease improvement. Moreover, the treatment should maintain till the complete recovery.