Early detection of breakthrough trichosporonosis by serum PCR in a cord blood transplant recipient being prophylactically treated with voriconazole.

An 18-year-old man with myelodysplastic syndrome after stem-cell transplantation developed breakthrough trichosporonosis while being administered voriconazole, a broad-spectrum triazole. Importantly, Trichosporon was detected soon after infection by a screening serum polymerase chain reaction test, but not by blood culture. This case illustrates that the serum polymerase chain reaction assay might be effective for early detection of fungemia in immunocompromised patients, including recipients of stem-cell transplants undergoing prophylactic antifungal therapy using voriconazole, which cannot be assumed to always provide complete protection against Trichosporon infection.