Tinea Capitis Caused by Trichosporon asahii in an Immunocompetent Child: A Case Report

Background：Trichosporon asahii is an emerging opportunistic yeast that often causes fatal disseminated infections in immunocompromised individuals. Due to the rarity of such infections, there is currently no standardized treatment guideline. Tinea capitis is the most common superficial fungal infection in children. In China, the predominant causative organisms include Microsporum canis, Trichophyton violaceum, T. mentagrophytes, T. tonsurans, and T. rubrum. Here, we report a rare case of tinea capitis caused by T. asahii in an immunocompetent child, which posed significant diagnostic and therapeutic challenges. Case presentation：The patient was a 4-year-old boy with a history of atopic dermatitis. Fungal cultures of purulent secretions from scalp lesions in the occipital region repeatedly yielded Trichosporon asahii. After hospital admission, he developed fever and worsening of his atopic dermatitis. Following systemic antifungal therapy with itraconazole and anti-inflammatory treatment with prednisone and dupilumab, his condition significantly improved. Both the scalp lesions and lymphadenopathy subsided, and follow-up showed sustained clinical remission. Conclusion：The diagnosis of Trichosporon infection relies on a high index of clinical suspicion and confirmation through microbiological testing. T. asahii can cause superficial fungal infections even in children without underlying conditions, underscoring the need for clinicians to remain vigilant in cases that respond poorly to conventional antifungal therapy. When necessary, definitive pathogen identification should be performed, and systemic antifungal treatment should be initiated early to improve clinical outcomes.