Cutaneous Paecilomyces lilacinus infection: Report of two novel cases

Hecker, Melanie S.; Weinberg, Jeffrey M; Bagheri, Bita; Tangoren, Ibrahim A.; Rudikoff, Donald; Bottone, Edward J.; Bilodeau-McCarthy, Elise; Rudolph, Robert I.; Phelps, Robert

doi:10.1016/s0190-9622(97)80139-9

Cited by 32 publications

(26 citation statements)

References 11 publications

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“…The most frequent clinical manifestations are oculomycosis and cutaneous and subcutaneous infections [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Less frequently, however, this fungus can also disseminate, probably due to this ability to sporulate in tissue, producing numerous conidia that spread haematogenously [1,20].…”

Section: Introductionmentioning

confidence: 99%

“…Amphotericin B (AMB) is probably the most commonly used drug for treating this infection, with most of the results being negative or unknown [6,8,10,15,[21][22][23][24][25][26], in agreement with the poor in vitro response of P. lilacinus to this antifungal drug [1,27,28]. There is little data on the activity of the newer triazoles either in vitro [28,29] or in animal models [1,30], but the available data are promising.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of voriconazole in a murine model of invasive paecilomycosis

Rodríguez

Pastor

Serena

et al. 2010

International Journal of Antimicrobial Agents

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We studied the efficacy of voriconazole (VRC) and amphotericin B (AMB) in an immunosuppressed murine model of disseminated infection by two strains of Paecilomyces lilacinus. Mice were treated with VRC 60 mg/kg/day orally or AMB 3 mg/kg/day intraperitoneally, beginning 1 day after infection and continuing for 9 days. To avoid rapid clearance of VRC, animals receiving VRC and the control group were given grapefruit juice instead of water. VRC significantly prolonged survival with respect to the group treated with AMB and the control group for both strains (P = 0.005 and P < 0.0001, respectively, for strain FMR 5522; and P = 0.0002 and P < 0.0001, respectively, for strain FMR 8252). VRC reduced the fungal load in the spleen, kidneys and liver of infected mice for both strains tested. Survival of mice challenged with strain FMR 8252 treated with AMB did not differ from that of the control group (P = 0.223), being worse than that of the mice treated with VRC (P = 0.0002). AMB was not able to reduce the tissue burden in any organ with respect to the control group for both strains studied.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of voriconazole in a murine model of invasive paecilomycosis

Rodríguez

Pastor

Serena

et al. 2010

International Journal of Antimicrobial Agents

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“… 10 Hecker et al . 11 reported both successful treatment with oral itraconazole in a healthy 86‐year‐old man with a left index finger sore and unsuccessful treatment with oral itraconazole, intravenous amphotericin B, and topical miconazole in a 56‐year‐old liver transplant recipient with lower extremity cellulitis who succumbed 16 months post‐transplant. Orth et al .…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Paecilomyces lilacunis infection in a hospitalized patient taking corticosteroids

Marchese

Smoller

1998

Int J Dermatology

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A 72‐year‐old Caucasian man presented with tender, hyperkeratotic, violaceous, ill‐defined, scattered plaques associated with minimal pitting edema of the right upper extremity. He had been discharged 3 days earlier from an outlying community hospital after a 33‐day admission for exacerbation of chronic obstructive lung disease requiring large doses of systemic corticosteroids. A right subclavian central venous line for intravenous access was placed after he developed a gastrointestinal bleed and myocardial infarction. The clinical differential diagnosis of the eruption on the right upper extremity at the time he presented to our service included cellulitis, deep venous thrombosis, and brachial plexus neuropathy. Brachial plexus neuropathy was ruled out with normal electromyography, nerve conduction studies, and cervical spine radiographs. Deep venous thrombosis was never completely eliminated, because the patient refused a venogram and the venous Doppler exam was nondiagnostic. Treatment for a presumed bacterial cellulitis was initiated with Nafcillin intravenously. As there was clinical disease progression without appreciable improvement by day nine ( Fig. 1 and 2), a skin biopsy was performed and topical Nystatin powder was added for possible yeast etiology. Bacterial cultures were negative; however, fungal cultures on Sabouraud’s agar were positive for Paecilomyces lilacunis after 15 days. Histologic sections demonstrated skin with an essentially normal epidermis. Within the dermis, there was an extensive, mixed, granulomatous inflammatory infiltrate with abundant multinucleated giant cells. Necrosis was not abundant. Occasional 8–12 μm yeast‐like organisms were apparent within the cytoplasm of multinucleated cells and in an extracellular location, together with occasional hyphal forms with irregular branching. Periodic acid–Schiff (PAS) with diastase and Gomori methenamine silver accentuated the staining and confirmed the fungal nature of the organisms ( Fig. 3). The histologic differential included various other fungi. Cryptococcus is usually smaller, endospores characteristic of coccidiomycosis were not present, and a thick capsule usually seen in blastomycosis was not observed in these organisms. The diagnosis of Paecilomyces lilacunis was established, and itraconazole 200 mg orally twice a day was instituted. Clinical improvement as measured by decreased edema, increased range of motion, and resolution of cutaneous lesions was dramatic during the first week. Itraconazole was decreased to 200 mg a day and the patient continued to improve. He was discharged to home. He has followed up in our clinic every month with complete resolution to date 7 months after discharge. 1 Right upper extremity demonstrating violaceous hue, edema, and scale taken after 9 days of Nafcillin. Note progression of disease to involve the left upper extremity 3 Gomori methenamine silver stain reveals multiple 8–12 μm organisms. Original magnification, 400×

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“…In the case above, the extent of infection was too great soft-tissue infection in a heart transplant recipient and its successful to allow debridement. Antifungal therapy has also been successful treatment with terbinafine, a therapeutic agent not previously deagainst paecilomyces infection [2][3][4][5]. Agents reported to be useful scribed for use against paecilomyces infection.…”

Section: Recipient and Successful Treatment With Terbinafinementioning

confidence: 99%

“…against Paecilomyces include miconazole, griseofulvin, amphoteri-A 48-year-old man underwent heart transplantation for obstruccin B (alone or with 5-FC), ketoconazole, and itraconazole [2][3][4][5]. tive cardiomyopathy in December 1995.…”

Section: Recipient and Successful Treatment With Terbinafinementioning

confidence: 99%

Paecilomyces lilacinusInfection in a Heart Transplant Recipient and Successful Treatment with Terbinafine

Clark

1999

CLIN INFECT DIS

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Cutaneous Paecilomyces lilacinus infection: Report of two novel cases

Cited by 32 publications

References 11 publications

Efficacy of voriconazole in a murine model of invasive paecilomycosis

Efficacy of voriconazole in a murine model of invasive paecilomycosis

Cutaneous Paecilomyces lilacunis infection in a hospitalized patient taking corticosteroids

Paecilomyces lilacinusInfection in a Heart Transplant Recipient and Successful Treatment with Terbinafine

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