Invasive Trichoderma longibrachiatum breakthrough infection in a hematology patient

Author: mycolabadmin
6/14/2025
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Summary

A 61-year-old woman with blood cancer developed a severe and unusual double fungal infection caused by two mold species while being treated for a known fungal infection. Despite receiving multiple antifungal medications, her condition worsened and she ultimately died from multiple organ failure. The case is important because it demonstrates how Trichoderma fungi are becoming dangerous pathogens in very sick, immunocompromised patients, and a new drug called olorofim showed promising activity against this infection in laboratory tests.

Background

Trichoderma species are emerging as serious pathogens causing invasive fungal infections, particularly in immunocompromised patients such as those with hematological malignancies and transplant recipients. Previously considered merely as contaminants, these filamentous fungi have recently been associated with high mortality rates in vulnerable populations. This case report documents a rare and severe co-infection in a critically ill hematology patient.

Objective

To describe a case of invasive Trichoderma longibrachiatum breakthrough infection occurring concurrently with Aspergillus fumigatus infection in a neutropenic hematology patient and to characterize the antifungal susceptibility profile of the isolated pathogen. The report aims to contribute to understanding of this emerging opportunistic infection in immunocompromised hosts.

Results

The patient developed a breakthrough infection with Trichoderma longibrachiatum while receiving liposomal amphotericin B for probable invasive pulmonary aspergillosis. Fungal cultures from four separate bronchoalveolar lavage samples grew T. longibrachiatum, with susceptibility testing showing resistance to isavuconazole but susceptibility to amphotericin B, voriconazole, itraconazole, and notably olorofim (MIC 0.016 mg/L). Despite combination antifungal therapy with amphotericin B, isavuconazole, and caspofungin, the patient developed multiple organ failure and died 34 days after admission.

Conclusion

This case highlights the emergence of Trichoderma longibrachiatum as a serious invasive mold pathogen in severely immunocompromised hematology patients with high mortality despite appropriate combination antifungal therapy. Olorofim demonstrates promising in vitro activity against T. longibrachiatum and may represent a valuable therapeutic option for such difficult-to-treat infections. Heightened clinical awareness and rapid identification of Trichoderma species are critical for improving outcomes in invasive infections caused by these emerging pathogens.

Published in:Medical Mycology Case Reports,
Study Type:Case Report,
Source: PMID: 40584597, DOI: 10.1016/j.mmcr.2025.100709