Een diepe mycose met mycobacteriële co-infectie aan de onderarm van een veearts -het belang van spiegelbepaling

D. J. Kadouch*, C. J. Hodiamont, M. Jonkman, H. J.C. De Vries

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    A 45-year-old man was unsuccessfully treated with various systemic antibiotics and antifungals for a growing purulent erythematous plaques on the right hand. After diagnosing a deep fungal infection (based on positive cultures for four different species: Aspergillus Niger, Penicillium species, Paraconyothyrium species and Mucor species) voriconazole 200 mg 2 dd was started. After a few months a voriconazole serum level was determined and revealed a sub-therapeutic concentration. After increasing the dose, therapeutic levels were reached and the lesion went into remission. After several months of treatment the plaque again started to grow. Because of a suspected anti-fungal resistance voriconazole was substituted with posaconazole. Repeated biopsies for microbiological testing where obtained and acid-fast rods were seen suggesting a non-tuberculous (atypical) mycobacterial infection. Pharmacokinetic analysis is vital in the treatment of deep mycoses with new classes of antifungal drugs such as voriconazole becoming available. Repeated diagnostics to exclude anti-mycotic resistance and other pathogenic micro-organisms is warranted in case of therapy resistant deep fungal infections.

    Original languageDutch
    Pages (from-to)285-287
    Number of pages3
    JournalNederlands Tijdschrift voor Dermatologie en Venereologie
    Volume26
    Issue number5
    Publication statusPublished - 1-May-2016

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