title: Treatment of fungal myositis with intra-lesional and intravenous itraconazole: a case report.
abstract: BACKGROUND
  Fungal myositis is very uncommon, even in patients who are immunocompromised. Because of its rarity and a lack of clinical experience, no consensus has been reached about the best means of treating fungal myositis. To the best of our knowledge this is the first description of the treatment of fungal myositis with simultaneous intravenous and intra-lesional itraconazole.
  
  
  METHODS
  A 35-year-old Chinese woman with acute myelomonocytic leukemia developed Candida krusei fungemia and fungal myositis in the right biceps brachii after chemotherapy. A course of intravenous itraconazole and subsequently intravenous voriconazole was initiated and her blood cultures became sterile; however, our patient remained febrile and the myositis did not resolve. Intravenous itraconazole was restarted simultaneously with low-dose intra-lesional itraconazole. The pyrexia settled after 48 hours and within 10 days the lesion could be seen to be resolving. After the course of intravenous and intra-lesional anti-fungals was complete, oral itraconazole was administered as maintenance therapy.
  
  
  CONCLUSIONS
  To the best of our knowledge this is the first case in which fungal myositis was successfully treated with intravenous and intra-lesional itraconazole in a patient with acute myelomonocytic leukemia. The efficacy and safety of locally-administered itraconazole to treat intractable soft tissue infections requires further evaluation.
authors.affiliation: Department of Haematology, The Second Affiliated Hospital of Wenzhou Medical College, Zhejiang, China. yaorx828@163.com.
authors.forename: Xiao-Ji
authors.initials: XJ
authors.lastname: Lin
authors.forename: Rong-Xin
authors.initials: RX
authors.lastname: Yao
authors.forename: Mu-Qing
authors.initials: MQ
authors.lastname: He
authors.forename: Bao-Ling
authors.initials: BL
authors.lastname: Zhu
authors.forename: Wen-Jian
authors.initials: WJ
authors.lastname: Guo