title: Extensive long-standing chromomycosis due to Fonsecaea pedrosoi: three cases with relevant improvement under voriconazole therapy.
abstract: OBJECTIVE
  To evaluate voriconazole in the treatment of extensive cases of chromomycosis. Chromomycosis is a chronic infection, which is extremely difficult to eradicate, and is caused by dematiaceous (dark-colored) fungi which affect the skin and subcutaneous tissues, with Fonsecaea pedrosoi being the major etiologic agent. Drugs such as itraconazole, terbinafine, posaconazole and amphotericin B have been employed with variable results.
  
  
  METHODS
  We treated three Caucasian male patients (ages 44, 57 and 77 years), two were farmers and one a trash collector, with long-standing (20, 10 and 21 years of disease, respectively) and extensive chromomycosis (one lower limb affected, at least) due to Fonsecaea pedrosoi. All patients had received previous therapy with the formerly indicated drugs itraconazole and terbinafine for several months either without or with incomplete response. After that, we started treatment with voriconazole per os 200 mg twice a day.
  
  
  RESULTS
  The patients were treated with voriconazole for 12 months until there was clinical and mycological improvement. Clinical response was evident after 30-50 days. One patient developed visual abnormalities and tremors, and the voriconazole was reduced to 200 mg/day without impairment of the clinical and mycological response. The same patient presented photosensitive dermatitis after 12 months of therapy and the voriconazole was stopped. All patients showed elevations of serum gamma-glutamyl transpeptidase (GGT) during the treatment without clinical relevance. Moreover, our three patients obtained partial response with this therapy.
  
  
  CONCLUSIONS
  This is the first report with a case series of chromomycosis treated with voriconazole. Despite its high cost, voriconazole is a safe and possibly promising drug for use on extensive chromomycosis refractory to conventional treatment.
authors.affiliation: Dermatology Department, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. prcriado@usp.br
authors.forename: Paulo Ricardo
authors.initials: PR
authors.lastname: Criado
authors.forename: Mariana Figueiroa
authors.initials: MF
authors.lastname: Careta
authors.forename: Neusa Y S
authors.initials: NY
authors.lastname: Valente
authors.forename: José Eduardo Costa
authors.initials: JE
authors.lastname: Martins
authors.forename: Evandro A
authors.initials: EA
authors.lastname: Rivitti
authors.forename: Ricardo
authors.initials: R
authors.lastname: Spina
authors.forename: Walter
authors.initials: W
authors.lastname: Belda
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota; D002862:Chromoblastomycosis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole