Successful control of Scedosporium prolificans septic arthritis and probable osteomyelitis without radical surgery in a long-term renal transplant recipient.
Scedosporium species are increasingly isolated from immunocompromised and immunocompetent patients. Scedosporium infections are generally resistant to multiple antifungals, and Scedosporium prolificans is particularly resistant to all single antifungal agents currently in use with in vitro testing. We report here a long-term renal transplant recipient who developed isolated S. prolificans septic monoarthritis and probable osteomyelitis. The infection was successfully treated with a combination of voriconazole and terbinafine in addition to joint washout but did not require radical surgery. This combination has been shown to have synergistic in vitro effect, and anecdotal in vivo success has also been reported recently. We also review the clinical presentation, treatment, and outcome of S. prolificans infection in patients with solid organ transplantation.
Li
J Y Z
JY
Department of Nephrology and Transplantation Services, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Yong
T Y
TY
Grove
D I
DI
Coates
P T H
PT
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D003646:Debridement; D004359:Drug Therapy, Combination; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008271:Mycetoma / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D009281:Naphthalenes / Q000627:therapeutic use; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D011743:Pyrimidines / Q000627:therapeutic use; D021681:Scedosporium / Q000187:drug effects*; D000077291:Terbinafine; D013997:Time Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D009281:Naphthalenes; D011743:Pyrimidines; D014230:Triazoles; D000077291:Terbinafine; D065819:Voriconazole