Fatal invasive Trichosporon asahii infection with exophytic bronchial lesions in a patient with lymphoma undergoing CAR T-cell therapy.

Fungal infections are increasingly observed in immunocompromised patients, with non-Candida yeasts such as Trichosporon asahii emerging as significant opportunistic pathogens. T. asahii is a basidiomycetous yeast capable of causing disseminated disease in profoundly immunosuppressed hosts, particularly those with haematological malignancies or receiving cellular therapies. Diagnosis is often challenging due to morphological similarities with Cryptococcus and the limited sensitivity of conventional methods, while treatment is complicated by intrinsic resistance to echinocandins and high mortality despite azole therapy.We report a fatal case of disseminated T. asahii infection in a woman in her 50s with refractory diffuse large B-cell lymphoma undergoing chimeric antigen receptor T-cell therapy. On day 8 post-infusion, she developed hypoxia, haemodynamic instability and acute renal failure requiring intensive care. Bronchoscopy revealed exophytic right main bronchial lesions, and T. asahii was isolated from bronchoalveolar lavage and blood cultures. Despite early voriconazole therapy, the patient died of septic shock.