title: Posaconazole as rescue therapy in African histoplasmosis.
abstract: African histoplasmosis is a granulomatous mycosis caused by Histoplasma capsulatum var. duboisii. Treatment is usually extrapolated from guidelines for classical histoplasmosis, and includes 2-4 weeks of amphotericin B followed by a step-down maintenance therapy with itraconazole. Pediatric usage of posaconazole, an oral second-generation azole, remains off-label, but recent surveys show that it is safe and well tolerated in children. We report a case of disseminated African histoplasmosis in a 12-year-old boy from Guinea-Bissau. Therapy with amphotericin B and itraconazole led to a progressive clinical deterioration. A dramatic and lasting improvement was observed using posaconazole. He completed 12 months of therapy. No relapse was noted during or 3 months after treatment. We report that posaconazole may be a safe and efficacious drug in the salvage management of disseminated AH, either in patients with disease refractory to conventional anti-fungal therapy, or in patients whose serious adverse effects of first-line drugs preclude its use.
authors: Serviço de Pediatria do Centro Hospitalar de São João, Porto, Portugal. danieldiasgoncalves@gmail.com
authors: Daniel
authors: D
authors: Gonçalves
authors: Catarina
authors: C
authors: Ferraz
authors: Luisa
authors: L
authors: Vaz
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D006660:Histoplasmosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole