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[Case of Scedosporium apiospermum cutaneous soft tissue infection treated with voriconazole].

Abstract
A 69-year-old man treated with corticosteroids and immunosuppressive agents for acutely exacerbated interstitial pneumonia was found to have an ingrown nail in the left big toe and that suppurated despite treatment by dermatologists. Culture of the pus expressed from the toe yielded Scedosporium apiospermum. The patient suffered liver dysfunction a few days later when treated with intravenous voriconazole (VRCZ), which was discontinued due to the high plasma VRCZ concentration. Discrete erythema and subcutaneous nodules developed in left leg 2 or 3 weeks later. Ultrasonography showed tubular structures with substantial echoes that were not connected to veins in the subcutaneous tissue of the left leg. These findings suggested a nodular lymphangitic pattern of spreading of S. apiospermum soft tissue infection. Oral VRCZ at 100 mg/day was started, and increased to 200 mg/day after the plasma VRCZ concentration was measured. VRCZ was stopped after about 2 months, by which time the man had fully recovered. Because VRCZ-induced liver dysfunction was reported significantly associated with plasma level, we treated this case safely by administering VRCZ while measuring the plasma concentration.
AuthorsMitsuru Konishi, Shinsuke Yonekawa, Chiyo Nakagawa, Kenji Uno, Kei Kasahara, Eiichiro Yoshimoto, Koichi Maeda, Keiichi Mikasa
JournalKansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases (Kansenshogaku Zasshi) Vol. 82 Issue 2 Pg. 82-5 (Mar 2008) ISSN: 0387-5911 [Print] Japan
PMID18411765 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Voriconazole
Topics
  • Administration, Oral
  • Aged
  • Antifungal Agents (administration & dosage, adverse effects, blood)
  • Dermatomycoses (drug therapy)
  • Humans
  • Immunocompromised Host
  • Infusions, Intravenous
  • Male
  • Mycetoma (drug therapy, microbiology)
  • Pyrimidines (administration & dosage, adverse effects, blood)
  • Scedosporium (isolation & purification)
  • Soft Tissue Infections (drug therapy)
  • Treatment Outcome
  • Triazoles (administration & dosage, adverse effects, blood)
  • Voriconazole

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