title: Rhino-cerebral zygomycosis resistant to antimycotic treatment: a case report.
abstract: We report a fatal case of a rhino-cerebral zygomycosis, caused by Rhizopus arrhizus (oryzae). The patient was suffering from idiopathic thrombopenic purpura, diagnosed 1 year earlier. He was already treated with methylprednisolone 5 months prior to his admission to the hospital for a loss of vision and pain in the left eye as well as left orbital cellulitis. After an initial empirical treatment with broad spectrum antibiotics and voriconazole (infection of unknown origin), the patient was treated with liposomal amphotericin as soon as a positive fungal culture revealed a zygomycete. Unfortunately, the mould was resistant to amphotericin B (MIC: 16 microg ml(-1)) and probably to posaconazole (MIC: 4 microg ml(-1)), which was co-administrated a few days later.
authors.forename: Timoleon-Achilleas
authors.initials: TA
authors.lastname: Vyzantiadis
authors.forename: Anna
authors.initials: A
authors.lastname: Kioumi
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Papadakis
authors.forename: Margarita
authors.initials: M
authors.lastname: Braimi
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Dermitzakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsitouridis
authors.forename: Antonios
authors.initials: A
authors.lastname: Antoniadis
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000494:pharmacology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications; D011743:Pyrimidines / Q000627:therapeutic use; D012220:Rhinitis / Q000188:drug therapy / Q000382:microbiology*; D012233:Rhizopus / Q000302:isolation & purification*; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use; D065819:Voriconazole; D020096:Zygomycosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B; D065819:Voriconazole; D008775:Methylprednisolone