Treatment of refractory chromomycosis by isolated limb infusion with melphalan and actinomycin D.
BACKGROUND
Chromomycosis is frequently resistant to systemic and local therapies, and advanced bulky disease can compromise limb function.


METHODS
A man developed extensive chromomycosis of the left arm, refractory to multiple systemic and local treatments. Regional chemotherapy with the isolated limb infusion (ILI) technique using melphalan and actinomycin D markedly reduced disease bulk and greatly improved function of the arm over the next 2 months. Repeat ILI was performed 10 months later, again with good improvement in mobility of the elbow and significant debulking of disease. At the present time, there is some persistent but stable disease, which is controlled by heat therapy with disposable pocket warmers. The patient declined any further systemic therapy.


CONCLUSIONS
ILI rapidly reduced disease bulk, restoring the limb to normal function within a few weeks. Although not curative, ILI could be an effective adjunctive treatment for severe chromomycosis in patients resistant to or intolerant of other therapies.
Damian
Diona L
DL
Department of Dermatology and Melanoma and Skin Cancer Research Institute, Sydney Cancer Centre, University of Sydney at Royal Prince Alfred Hospital, NSW, Australia. diona.damian@email.cs.nsw.gov.au
Barnetson
Ross StC
RS
Thompson
John F
JF
D000368:Aged; D001132:Arm; D002862:Chromoblastomycosis / Q000188:drug therapy*; D003609:Dactinomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use*; D010477:Perfusion / Q000379:methods*
D003609:Dactinomycin; D008558:Melphalan