amphotericin-b and Fasciitis

Aspergillus myofasciitis is a rare infection of the muscles and their fascial sheaths that has been reported in patients with immune deficiencies of various kinds but, until now, not with chronic granulomatous disease (CGD). Patients affected by CGD are at high risk of invasive aspergillus infections. The case described involves a 14-year-old boy with a severe autosomal recessive CGD who was admitted to hospital with an Aspergillus myofasciitis of the left forearm. He was treated with liposomal amphotericin for 14 days and then with oral voriconazole for three months with an excellent clinical outcome. He did not evidence any recurrence in the following 30 months using itraconazole prophylaxis.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Fasciitis; Forearm; Granulomatous Disease, Chronic; Humans; Interferon-gamma; Itraconazole; Male; Pyomyositis; Trimethoprim, Sulfamethoxazole Drug Combination

Necrotizing myofascial fungal infections of the upper extremity is a rare event even in immunocompromised hosts. We report the course of a renal transplant patient who developed extensive necrotizing myofascial infection of an upper extremity secondary to Histoplasma capsulatum. Initial, functional, upper limb salvage was achieved after aggressive surgical debridement and high doses of amphotericin B. The patient ultimately succumbed to systemic fungal sepsis. The etiology and treatment of these infections are discussed.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Fasciitis; Fatal Outcome; Forearm; Histoplasmosis; Humans; Kidney Transplantation; Male; Middle Aged; Myositis; Necrosis; Opportunistic Infections; Postoperative Complications

A 54-year-old man with dermatomyositis initially responsive to corticosteroids and methotrexate developed severe myalgias, increasing weakness, and fevers. Laboratory studies were suggestive of disseminated histoplasmosis, and muscle biopsy revealed myositis, fasciitis, and yeast in the perimysial connective tissue. Histoplasma capsulatum was cultured from skeletal muscle. Despite antifungal therapy, necrotizing fasciitis progressed to gluteal abscess formation. Disseminated histoplasmosis may present atypically in immunocompromised hosts as fasciitis and myositis. Patients with dermatomyositis could be particularly vulnerable to soft tissue invasion by fungi due to their underlying microangiopathy.

Topics: Abscess; Amphotericin B; Buttocks; Dermatomyositis; Diagnosis, Differential; Fasciitis; Histoplasmosis; Humans; Immunosuppression Therapy; Itraconazole; Magnetic Resonance Imaging; Male; Middle Aged; Muscles; Myositis