A 23-month-old boy, a victim of
acute myelomonocytic leukemia (AML), was admitted for
chemotherapy. On the eighth hospital day, he started a one-week course of
chemotherapy with agents of
epirubicin and
cytosine arabinoside. Unfortunately, persistent
neutropenia, deteriorating
diarrhea and intermittently spiking
fever developed from the sixteenth hospital day. Initially,
ceftazidime and
amikacin were empirically utilized. Blood culture yielded Klebsiella pneumoniae and the
fever subsided for one day. Unfortunately,
oral mucositis and
catheter-induced
phlebitis developed subsequently. Subsequently, oral
nystatin and intravenous
oxacillin were added. The results of cultures from both blood and oral mucosal tissue yielded a fungus. Trichosporon beigelii. We changed from an oral
antifungal agent to intravenous
amphotericin B on the twenty-fourth hospital day. He presented signs of
septic shock with disseminated intravascular coagulopathy and expired on the twenty-fifth hospital day after failure to respond to aggressive
resuscitation. We report this case to emphasize that in cytotoxic
chemotherapy-induced granulocytopenic AML patients who have compromised immune systems, and who may manifest some signs or symptoms of
infection, and at the same time poorly respond to interventional
antibiotic treatment, the possibility of T. beigelii
infection can not be neglected.