Cutaneous Absidia corymbifera in a Lupus Nephritis Patient

Abstract

A 28-year-old farmer with class IV lupus nephritis presented with a two-week history of a right shin lesion. The lesion was purple in color, fungating, and indurated with a focus of deep ulceration at the inferior pole and punctate, bleeding from its surface. Three months earlier, he was started on induction immunosuppression for a relapse of his lupus nephritis. Since the diagnosis of lupus nephritis, nine years previously, he had had six flares of his disease and had been treated at different time points with cyclophosphamide, rituximab, and high-dose corticosteroids, without adverse events. Laboratory investigations showed improving kidney function (chronic kidney disease [CKD] stage IV) with reducing proteinuria, on his current immunosuppressive regimen. The differential diagnosis for this lesion was calciphylaxis, pyoderma gangrenosum, vasculitic lesion, or an infection. Histology and microbiological analysis confirmed the presence of Absidia corymbifera. He was treated with a combination of isavuconazole, reduction of his immunosuppressive agents, excision of the lesion, and skin grafting.

Diversity of Fungi Isolated from Potato Nematode Cysts in Guizhou Province, China

“…In our fungal isolates, we found pathogens of plant diseases from genera such as Pestalotiopsis [ 58 , 59 ], Volutella [ 60 , 61 ], Didymella [ 62 ], Xylaria [ 63 ], and Crinipellis [ 64 ]; the genus Coriolopsis which is associated with trees and one of the lignicolous fungi [ 65 ]; and Paraphaeosphaeria [ 66 ], Peroneutypa [ 67 ], and Phaeophlebiopsis [ 68 ], which are genera associated with the epiphytic fungi of plants. The fungi of the genus Absidia are usually isolated from soil, constituting the pathogens of many human diseases [ 69 , 70 , 71 , 72 ]. Gongronella is capable of hydrolyzing polymeric chitosan to produce oligomeric chitosan [ 73 ].…”

Recommendations on the use of azole antifungals in hematology-oncology patients

“…It has been suggested that, at least in the case of voriconazole, this effect could be caused by CYP2B6 inhibition [ 104 ]. In this regard, isavuconazole acts as an inducer of this isoenzyme, so it can a priori reduce cyclophosphamide concentrations with loss of efficacy [ 102 ], although some of the published data do not seem to confirm this [ 105 ].…”