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.
|Number of pages||3|
|Journal||Nederlands Tijdschrift voor Dermatologie en Venereologie|
|Publication status||Published - 1-May-2016|