title: Paradoxical response preceding control of Scedosporium apiospermum mycetoma with posaconazole treatment.
abstract: Mycetoma is a chronic granulomatous infection that is difficult to treat, notably when due to fungi such as Scedosporium apiospermum. Recent antifungal agents could be an option, but cases are rarely reported, and none with posaconazole. Paradoxical responses, defined as initial clinical worsening despite appropriate treatment, are common in tuberculosis but rare in deep mycoses in non-immunocompromised hosts. Hence, paradoxical responses in context other than mycobacterial infection in an immunocompromised host could provide insights into the pathophysiology and the optimal strategy for treatment. We report the first case of a mycetoma caused by S. apiospermum with bone involvement treated with posaconazole, and the paradoxical response observed at the beginning of the treatment. As with mycobacterial infections, a paradoxical response in deep mycosis could represent the earliest marker of therapeutic efficacy.
authors.affiliation: From the Internal Medicine and Infectious Disease H8, University Hospital of Poitiers , Poitier , France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Béraud
authors.forename: Nicole
authors.initials: N
authors.lastname: Desbois
authors.forename: Caroline
authors.initials: C
authors.lastname: Coyo
authors.forename: Danièle
authors.initials: D
authors.lastname: Quist
authors.forename: Benoit
authors.initials: B
authors.lastname: Rozé
authors.forename: Luc
authors.initials: L
authors.lastname: Savorit
authors.forename: André
authors.initials: A
authors.lastname: Cabié
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D000075202:Contraindications; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects; D008297:Male; D008271:Mycetoma / Q000188:drug therapy* / Q000382:microbiology; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D021681:Scedosporium / Q000187:drug effects / Q000502:physiology*; D014230:Triazoles / Q000008:administration & dosage
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole
keywords: Mycetoma; Scedosporium apiospermum; paradoxical reaction; posaconazole