Fatal disseminated Trichoderma longibrachiatum infection in an adult bone marrow transplant patient: Species identification and review of the literature

Trichoderma longibrachiatum was recovered from stool surveillance cultures and a perirectal ulcer biopsy specimen from a 29-year-old male who had rece ived an allogeneic bone marrow transplant for acute lymphoblastic leukemia. The amphotericin B (2.0 mu g/ml) and itraconazole (1.0 mu g/ml) MICs for t he organism were elevated. Therapy with these agents was unsuccessful, and the patient died on day 58 posttransplantation, At autopsy, histologic sect ions from the lungs, liver, brain, and intestinal wall showed infiltration by branching septate hyphae, Cultures were positive for Trichoderma longibr achiatum. While Trichoderma species have been recognized to be pathogenic i n profoundly immunosuppressed hosts with increasing frequency, this is the first report of probable acquisition through the gastrointestinal tract. Sa lient features regarding the identification of molds in the Trichoderma lon gibrachiatum species aggregate are presented.