title: [Clinical problems in medical mycology: Problem number 48].
abstract: We present the case of a 42-year-old man, HIV-positive, with low CD4(+) T cell count (31 cells/μl), who was admitted to Hospital de Infecciosas F. J. Muñiz in Buenos Aires (Argentina) due to a severe lower back pain. He had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic B and C viral hepatitis. A spinal cord CT scan showed two lytic bone lesions in L2 and L3. A bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin-resistant Staphylococcus aureus. Intravenous vancomycin was prescribed, together with a corset and physical rest. A few days later the patient presented with acute dermatitis with papules, vesicles, scales and erythema, which spread over the whole lumbar region. The mycological study of the scales led to the isolation in culture of Candida albicans and Candida parapsilosis. With the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3% salicylic acid and 6% benzoic acid, but only slow, partial improvement was observed. The treatment was changed to oral fluconazole at a daily dose of 200mg. With the latter the patient showed a rapid, complete clinical response.
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Messina
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Negroni
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina. Electronic address: santisog@hotmail.com.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Santiso
authors.affiliation: Unidad 10, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Isabel
authors.initials: I
authors.lastname: Soto
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Roxana
authors.initials: R
authors.lastname: Depardo
authors.affiliation: Unidad 10, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Maria Florencia
authors.initials: MF
authors.lastname: Villafañe
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marin
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Alicia
authors.initials: A
authors.lastname: Arechavala
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001915:Braces / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D002179:Candidiasis, Cutaneous / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D003428:Cross Infection / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications*; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D008159:Lumbar Vertebrae / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D013166:Spondylitis / Q000150:complications / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D015163:Superinfection; D016683:Supine Position; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D014640:Vancomycin; D015725:Fluconazole