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Chinwe Ohanu, MD¹, Ana S. Rosado-Collazo, MD¹, Diane Mankin-Cruz, MD¹, Paco Diaz, MD², Frankie Alvarado, MD¹ ¹Pavia Hospital, Internal Medicine Department, Pulmonology Section, Arecibo, Puerto Rico ²Pavia Hospital, Internal Medicine Department, Infectious Disease Section, Arecibo, Puerto Rico Abstract title: patient. Trichosporon asahii induced sepsis secondary to bronchopneumonia in an immunocompromised Background: Opportunistic fungal infections are a significant concern in immunocompromised patients, particularly those with hematologic malignancies. Trichosporon asahii is a rare but increasingly recognized cause of invasive fungal infections. This yeast-like organism, commonly found in soil, water, and normal human flora, can cause both superficial and systemic disease. Incidence is estimated at 0.4–0.6% among immunocompromised individuals, especially those with prolonged neutropenia or hematologic cancers. It is intrinsically resistant to echinocandins and associated with high mortality rates up to 80% especially when diagnosis or appropriate therapy is delayed. Diagnosis requires culture, microscopy, and molecular testing. Treatment should be guided by susceptibility, with azoles being preferred. Case Presentation: A 76 year old hispanic female with chronic myelogenous leukemia on chemotherapy, coronary artery disease, type 2 diabetes, and hypertension presented with progressive dyspnea, hemoptysis, generalized weakness, and non-radiating chest pain. Vital signs revealed BP 120/45 mmHg, pulse 120 BPM, oxygen saturation at 88% on 3L NC, and fever of 38.1°C. Chest X-ray showed haziness in the left lower lobe and increased perihilar markings suggestive of bronchopneumonia. Infectious workup including testing for COVID-19, influenza, TB, PCP, HIV , and Mycoplasma pneumoniae, was negative. She was initially treated with ceftriaxone and azithromycin, later escalated to cefepime due to lack of clinical improvement. Fiberoptic bronchoscopy revealed copious secretions bilaterally. Bronchoalveolar lavage was negative for AFB and cryptococcus; however, KOH prep was positive for Trichosporon asahii. Antibiotics were discontinued, and antifungal therapy with voriconazole was initiated. The patient gradually improved with reduced oxygen requirements, resolution of fever and respiratory distress. Discussion: Trichosporon asahii is an often overlooked fungal pathogen in immunocompromised hosts, frequently mimicking bacterial pneumonia and delaying diagnosis. Early bronchoscopy and fungal testing are critical in patients with non-resolving pneumonia. Prompt identification and targeted antifungal therapy significantly improve outcomes. This case highlights the importance of clinical vigilance and rapid escalation to fungal diagnostics in high-risk patients.