title: Successful Treatment of Primary Cutaneous Mucormycosis Complicating Anti-TNF Therapy with a Combination of Surgical Debridement and Oral Posaconazole.
abstract: Lipid formulations of amphotericin B remain the first-line antifungal therapy for invasive mucormycosis. Posaconazole is an alternative for salvage therapy, but its use as primary therapy is not recommended due to the paucity of clinical data. Here we describe the case of a 57-year-old diabetic woman receiving etanercept and prednisone for the treatment of psoriatic arthritis who developed primary cutaneous mucormycosis after a minor gardening injury. Infection was successfully treated with aggressive surgical debridement followed by a 6-week course of the new delayed-release tablet formulation of posaconazole and temporary withholding of anti-TNF treatment. Primary antifungal therapy with posaconazole can be considered in selected cases of cutaneous mucormycosis.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA, jfc31@med.miami.edu.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Camargo
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Cho-Vega
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy; D003646:Debridement; D003881:Dermatomycoses / Q000175:diagnosis* / Q000628:therapy; D048909:Diabetes Complications / Q000175:diagnosis / Q000628:therapy; D000068800:Etanercept / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis* / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D014230:Triazoles; C101425:posaconazole; D000068800:Etanercept; D011241:Prednisone