title: [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.
authors.affiliation: Center for Infectious Diseases, Department of General Medicine, Nara Medical University.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Konishi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yonekawa
authors.forename: Chiyo
authors.initials: C
authors.lastname: Nakagawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Uno
authors.forename: Kei
authors.initials: K
authors.lastname: Kasahara
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yoshimoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Maeda
authors.forename: Keiichi
authors.initials: K
authors.lastname: Mikasa
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D003881:Dermatomycoses / Q000188:drug therapy*; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D008297:Male; D008271:Mycetoma / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D021681:Scedosporium / Q000302:isolation & purification; D018461:Soft Tissue Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole