amphotericin-b and Erythema-Nodosum

Pregnant women with respiratory symptoms of pleuritic pain and productive cough should undergo evaluation for coccidioidomycosis. This should include a history of travel or residency in endemic areas and careful assessment for toxic erythema, erythema nodosum, or erythema multiforme. To confirm a diagnosis of this disease, a sputum culture, wet mount, and serological tests should be performed. The risk of dissemination, which is highest in the second and third trimesters, can be estimated by a complement-fixation titer. In disseminated cases aggressive treatment with amphotericin B has improved the previously reported high maternal and neonatal mortality rate. Fortunately, case reports do not indicate that transplacental spread occurs. Reactivation or exacerbation of a chronic low-grade infection during pregnancy may occur in patients treated for prior disseminated disease (32, 34). Interestingly, both of the reported cases of reactivation or exacerbation occurred in insulin-dependent diabetics.

Topics: Adult; Amphotericin B; Coccidioidomycosis; Diabetes Mellitus, Type 1; Erythema Multiforme; Erythema Nodosum; Female; Fetal Death; Humans; Insulin Infusion Systems; Opportunistic Infections; Pregnancy; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Pregnancy Trimester, Second

Topics: Amphotericin B; Arthritis, Infectious; Coccidioidomycosis; Eosinophilia; Erythema; Erythema Multiforme; Erythema Nodosum; Ethnicity; Female; Humans; Liver Diseases; Lung Diseases, Fungal; Meningitis; Miconazole; Osteomyelitis; Pregnancy; Pregnancy Complications, Infectious; Skin Diseases, Infectious; Tenosynovitis; Transfer Factor; United States

We report a case of visceral leishmaniasis (VL)/HIV coinfection in a patient undergoing regular antiretroviral therapy and treatment with thalidomide for erythema nodosum leprosum. He presented at a health service with high fever, chills, asthenia, pale skin, lower limb edema, hepatomegaly, and splenomegaly. Visceral leishmaniasis was confirmed by direct examination, and serological and molecular tests. Serum levels of Th1/Th2 cytokines were measured. The patient began treatment with liposomal amphotericin B, with good clinical response; however, VL recurred 6 months later. Treatment was reinitiated, maintaining secondary prophylaxis with liposomal amphotericin B. The patient showed clinical improvement with important recovery of CD4

Topics: Adult; Amphotericin B; Anti-Retroviral Agents; Coinfection; Erythema Nodosum; HIV Infections; Humans; Leishmaniasis, Visceral; Male; Recurrence; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Erythema Nodosum; Female; Fluconazole; Humans; Ketoconazole; Patient Selection; Pregnancy; Pregnancy Complications, Infectious; Risk Factors

Rheumatologic manifestations were noted in 24 (6.3%) of 381 patients with symptomatic histoplasmosis who were seen during a recent epidemic in Indianapolis. Typically, these patients had rapidly additive, rather than migratory, arthritis or arthralgia, which was symmetric in 50%. Ten patients had oligo- or monarticular disease. Knees, ankles, wrists, and small joints of the hand were the most common sites affected. Eleven patients had erythema nodosum. The rheumatologic manifestations were usually mild and, in all but 2 patients, resolved without treatment or with a brief course of nonsteroidal antiinflammatory drugs. The joint disease in patients with erythema nodosum was essentially the same as that seen in patients who did not develop skin lesions. However, those without erythema nodosum more frequently exhibited systemic features, e.g., chills, fever, anemia, and elevated erythrocyte sedimentation rates. Rheumatologic complaints led 16 of the patients in this series (67%) to seek medical attention, and in 3 patients they constituted the sole presenting complaint.

Topics: Adolescent; Adult; Amphotericin B; Anti-Inflammatory Agents; Arthritis; Child; Erythema Nodosum; Female; Histoplasmosis; Humans; Indiana; Male; Middle Aged; Prednisone

Two patients with blastomycosis and erythema nodosum are described. In one patient, the underlying blastomycosis resolved after wedge resection of the pulmonary infiltrate, but without chemotherapy. In the second patient, the underlying disseminated blastomycosis required amphotericin B therapy. Blastomycosis should be included in the differential diagnosis of erythema nodosum.

Topics: Aged; Amphotericin B; Blastomycosis; Erythema Nodosum; Humans; Male; Middle Aged