RESUMO
Chromoblastomycosis is a chronic fungal infection. Itraconazole and terbinaï¬ne are the most recommended antifungal drugs for chromoblastomycosis, while amphotericin B is not usually recommended. A patient with chromoblastomycosis in our hospital showed poor clinical responses to itraconazole and terbinaï¬ne. The fungus isolated from the lesions of this patient was identified as Fonsecaea nubica and numbered zssy0803. In vitro antifungal susceptibilities of F. nubica zssy0803 to terbinaï¬ne, amphotericin B, itraconazole, voriconazole and caspofungin were evaluated, as well as the combinations of terbinaï¬ne with the other four antifungals. The combined effect of terbinaï¬ne and amphotericin B on other 20 clinical F. nubica strains was also evaluated. The minimal inhibitory concentrations of terbinaï¬ne, amphotericin B, itraconazole, voriconazole and caspofungin on F. nubica zssy0803 were 0.25 µg/mL, 2 µg/mL, 1 µg/mL, 4 µg/mL and 8 µg/mL, respectively. The combination of terbinaï¬ne and amphotericin B showed the lowest fractional inhibitory concentration index of 0.28 to F. nubica zssy0803 in comparison with combinations of terbinaï¬ne and the other four antifungal drugs. The combination of terbinaï¬ne and amphotericin B was also synergistic for all the other 20 F. nubica strains. Then, the combination of oral terbinaï¬ne (500 mg/day) and intralesional injections of amphotericin B (1 mg/mL) was used to treat this patient. After this combined therapy for 25 weeks and terbinaï¬ne monotherapy for additional 12 weeks, the patient was cured. These findings indicate for the first time that terbinaï¬ne and amphotericin B are synergistic in killing F. nubica both in vitro and in vivo.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Ascomicetos/efeitos dos fármacos , Cromoblastomicose/tratamento farmacológico , Terbinafina/administração & dosagem , Ascomicetos/isolamento & purificação , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-IdadeRESUMO
Primary localized cutaneous amyloidosis is a skin-limited amyloidosis that does not involve internal organs. It is clinically subclassified into 3 general categories and some rare variants. However, there is considerable overlap within the classification. Though there are a variety of therapeutic measures, the treatment is often unsatisfactory, particularly when the disease is severe and extensive. We describe a rare case of primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions that showed an excellent response to systemic acitretin.
Assuntos
Acitretina/uso terapêutico , Amiloidose Familiar/tratamento farmacológico , Ceratolíticos/uso terapêutico , Dermatopatias Genéticas/tratamento farmacológico , Amiloidose Familiar/complicações , Amiloidose Familiar/diagnóstico , Feminino , Humanos , Erupções Liquenoides/complicações , Erupções Liquenoides/tratamento farmacológico , Dermatopatias Genéticas/complicações , Dermatopatias Genéticas/diagnóstico , Resultado do Tratamento , Adulto JovemRESUMO
Abstract: Primary localized cutaneous amyloidosis is a skin-limited amyloidosis that does not involve internal organs. It is clinically subclassified into 3 general categories and some rare variants. However, there is considerable overlap within the classification. Though there are a variety of therapeutic measures, the treatment is often unsatisfactory, particularly when the disease is severe and extensive. We describe a rare case of primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions that showed an excellent response to systemic acitretin.