Amphotericin B mg daily was prescribed

Amphotericin B 50mg daily was prescribed. However, acute renal failure with oliguria developed 4 days after treatment. Antifungal agent was shifted to voriconazole 400 mg daily (8 mg/kg). One week later, his skin lesions improved, leaving only slight erosion over the right arm (B). Due to symptoms of gastrointestinal upset that developed, the dosage of voriconazole was decreased to 200 mg daily and continued for another week. Then, icteric sclera developed. His family refused further antifungal treatment owing to his age, persistent dyspepsia, and the potential liver toxicity of the medication. However, recurrence of erosions and ulcerations were noted over the right arm days later. Voriconazole 200 mg daily (4 mg/kg) was reinitiated. Due to the deterioration of hepatic function, voriconazole was then decreased to 75 mg daily. Even under the adjusted dosage of voriconazole use, his skin condition gradually improved, leaving only scaling. During hospitalization, he developed a catheter-related blood stream infection with vancomycin-resistant and . Finally, the patient died from septic shock even under systemic WEHI-539 and a total of 11 weeks of voriconazole treatment. is a saprophytic fungus with a global distribution, such as soil and stagnant water, agricultural land, thorny shrubs, and in temperate climates. infections are uncommon, even in immunocompromised individuals. Caira et al reported that overall incidence of was about 0.08% in a 20-year retrospective survey of 8633 patients with newly diagnosed acute leukemia in Italy. From 1995 to 2014, there were only two reported cases of infection in Taiwan; one with mycetoma and the other with nonmycetoma at presentation. However, increased frequency and high mortality rates of invasive infections were noted in immunocompromised hosts. In an Australian surveillance study of , skin/subcutaneous tissue accounted for 14.5% of the primary sites of infection. The most common skin manifestations are multiple subcutaneous nodules in a sporotrichoid distribution after injuries. Other rare skin manifestations are non–mycetoma-like cutaneous and subcutaneous infections, which present as necrotic ulcer encased by a circumferential area of extensive skin sloughing, violaceous discoloration, and erythema. A similarity in clinical presentation was noted between our patient and that of the previously reported case mentioned above. has been reported to have very high levels of antifungal resistance, most notoriously to amphotericin B. Voriconazole is a compound with low minimal inhibitory concentration values. Micafungin and posaconazole are reported to have moderate activity against the majority strains of . A combination of two antifungal agents with different mechanisms or antifungal treatment used in combination with surgical intervention may be warranted for intractable cases. The synergistic interaction between azoles and terbinafine blocks different steps of the fungal ergosterol biosynthesis pathway. In a case report, surgical debridement and intralesional injection of voriconazole (a concentration of 3 mg/mL, once weekly for 2 weeks) were used to treat successfully a patient with a hepatic contraindication for voriconazole. Our patient had impaired liver function and underlying chronic hepatitic C status so azole could only be used sparingly. Extensive surgical debridement might not be appropriate for patients with advanced age. Intralesional injection of voriconazole may be considered in such patients. In summary, this is the first formally reported case of non-mycetomatous infection in an immunocompetent patient in Taiwan, who received oral voriconazole but eventually died of a hospital-acquired infection.
Hypertrichosis lanuginosa acquisita (HLA) is a paraneoplastic hair disorder, which is characterized by fine, long, nonpigmentous hair on the face. HLA could evolve in association with nonmalignant disorders such as human immunodeficiency virus, hyperthyroidism, hypothyroidism and with use of certain drugs. Malignancy-related HLA is predominant in female patients, and the most commonly associated malignancy in female patients with HLA is a colon adenocarcinoma. Literature reports regarding lymphoma-related HLA are rare. So far, only two lymphoma-associated HLA cases have been reported in the literature. In both cases, the patients were female. Herein, we present the case of a systemic diffuse large B-cell lymphoma-associated HLA.