A Case of <I>Scedosporium apiospermum</I> Cutaneous Soft Tissue Infection Treated with Voriconazole

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Other Title
  • Voriconazoleで治療した<I>Scedosporium apiospermum</I>皮膚軟部組織感染症の1例
  • 症例 Voriconazoleで治療したScedosporium apiospermum皮膚軟部組織感染症の1例
  • ショウレイ Voriconazole デ チリョウシタ Scedosporium apiospermum ヒフ ナンブ ソシキ カンセンショウ ノ 1レイ
  • A Case of Scedosporium apiospermum Cutaneous Soft Tissue Infection Treated with Voriconazole

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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 200mg/day after the plasma VRCZ concentration was measured. VRCZ was stopped after about 2 months, by which time the man had fully recovered.<BR>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.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 82 (2), 82-85, 2008

    The Japanese Association for Infectious Diseases

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