amphotericin-b and Leg-Ulcer

Topics: Amphotericin B; Biopsy, Needle; Chronic Disease; Diagnosis, Differential; Humans; Immunohistochemistry; Infusions, Intravenous; Leg Ulcer; Leishmaniasis, Visceral; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Wound Healing

Primary cutaneous mucormycosis is an opportunistic fungal infection caused by the order Mucorales, most frequently by the Rhizopus species. Both systemic factors, such as diabetes mellitus or malignancies and local factors disrupting the skin barrier are implicated in development of this entity. The initial manifestation is a red-to-black papule rapidly progressing to a necrotic and painful ulcer. Diagnosis is obtained by identification of fungal forms in a skin biopsy, typically showing branching and non-septate hyphae. The clinical course is highly variable and depends mostly on the fungal invasion of deep tissues. However, an early diagnosis is essential for implementation of prompt and optimal treatment, based upon antifungal therapy and aggressive surgical debridement.

Topics: Adrenal Cortex Hormones; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Cross Infection; Debridement; Dermatomycoses; Equipment Contamination; Fluorouracil; Humans; Immunocompromised Host; Leg Ulcer; Leucovorin; Male; Mucormycosis; Organoplatinum Compounds; Rectal Neoplasms; Urinary Catheterization

Topics: Adult; Amphotericin B; Biopsy, Needle; Chronic Disease; Debridement; Diagnosis, Differential; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Immunocompromised Host; Immunohistochemistry; Kidney Transplantation; Leg Ulcer; Mucormycosis; Opportunistic Infections; Rhizopus; Transplantation Immunology; Treatment Outcome

This is a case of mucormycosis complicated by necrotizing fasciitis in a renal transplant recipient on immunosuppressive therapy treated with posaconazole. Mucormycosis occurs most commonly as an opportunistic infection in the immunocompromised host. This patient, with predisposing risk factors for infection, including diabetes mellitus status post cadaveric renal transplantation on immunosuppressive therapy, is the first reported case of successful treatment of Mucor involving an extremity which was neither fatal nor required extremity amputation.

Topics: Alcaligenes; Amphotericin B; Amputation, Surgical; Antifungal Agents; Cefazolin; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Drug Combinations; Drug Resistance, Multiple, Fungal; Escherichia coli Infections; Fatal Outcome; Fluconazole; Gangrene; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Leg; Leg Ulcer; Male; Middle Aged; Mucor; Mucormycosis; Penicillanic Acid; Phosphatidylcholines; Phosphatidylglycerols; Piperacillin; Postoperative Complications; Pyrimidines; Renal Dialysis; Reoperation; Sepsis; Skin Transplantation; Tazobactam; Triazoles; Voriconazole

A case of zygomycosis presenting with non-healing multiple discharging sinuses in a diabetic patient is reported here. The debrided tissue on histopathological examination revealed dense infiltration with aseptate fungal hyphae. Potassium hydroxide mount showed hyaline aseptate hyphae suggestive of zygomycosis. On culture, Absidia corymbifera was isolated. The patient responded to surgical debridement and therapy with amphotericin B followed by itraconazole.

Topics: Absidia; Amphotericin B; Antifungal Agents; Cicatrix; Diagnosis, Differential; Humans; Itraconazole; Leg Ulcer; Male; Middle Aged; Zygomycosis

A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fatal Outcome; Female; Humans; Leg Ulcer; Lupus Erythematosus, Systemic; Middle Aged; Mucormycosis; Rhizopus

An immunosuppressed patient who presented with unusual clinical signs of cutaneous alternariosis, including papular, nodular and verrucous lesions of the forearms, is reported. In spite of continuous treatment with oral itraconazole for 6 months, a large, progressive, necrotic ulcer appeared on the patient's left leg. Liposomal amphotericin B was then administered (total dose, 750 mg) with excellent clinical results.

Topics: Alternaria; Amphotericin B; Antifungal Agents; Biopsy, Needle; Dermatomycoses; Follow-Up Studies; Humans; Immunocompromised Host; Immunohistochemistry; Kidney Transplantation; Leg Ulcer; Liposomes; Male; Middle Aged; Opportunistic Infections; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Behcet Syndrome; Cryptococcosis; Cryptococcus neoformans; Glucocorticoids; Humans; Leg Ulcer; Male; Prednisone

Topics: Alternaria; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Dermatomycoses; Female; Foot Ulcer; Humans; Immunocompromised Host; Immunosuppression Therapy; Kidney Transplantation; Leg Ulcer; Middle Aged; Postoperative Complications

Topics: Aged; Amphotericin B; Antifungal Agents; Debridement; Erythema; Fatal Outcome; Female; Humans; Leg Ulcer; Mucormycosis

Cutaneous mucormycosis followed trivial injury to the leg of a 72-year-old man. The lesion progressed rapidly requiring above-knee amputation.

Topics: Aged; Amphotericin B; Ampicillin; Dermatomycoses; Drug Combinations; Floxacillin; Humans; Ketoconazole; Leg Ulcer; Male; Mucormycosis

Two cases of cutaneous phycomycosis in the form of diabetic leg ulcers were diagnosed by culture and biopsy demonstration of invasive fungal infection. The first patient had an infected vesicular skin lesion. Systemic amphotericin B therapy and repeated debridement were curative. A posttraumatic leg ulcer developed in the second patient in the setting of hyperglycemia and renal insufficiency. Aggressive infection necessitated a curative amputation. Phycomycetes can cause or complicate diabetic leg ulcers and such infections may require biopsy for early recognition and subsequent successful therapy.

Topics: Aged; Amphotericin B; Debridement; Dermatomycoses; Diabetes Complications; Female; Humans; Leg Ulcer; Middle Aged; Mucormycosis

For ten years, a 25-year-old immune-competent man experienced a progressive disseminated infection with the saprophytic soil fungus, Curvularia lunata, following presumptive cutaneous inoculation while playing football. Deep, soft tissue abscesses, pulmonary suppuration, paravertebral abscess, and cerebral abscess all followed leg ulcers from neglected abrasions. The patient's delay in obtaining treatment was partially responsible for the paravertebral-mediastinal-pleural-cutaneous fistula that resulted. The importance of prompt and aggressive surgical drainage procedures is clear. Infection was arrested only by surgery. The fungus was inhibited by miconazole nitrate and amphotericin B but it developed resistance to flucytosine. Miconazole appeared to cause resolution of the cerebral abscess. Amphotericin B (1 mg/kg/day) clearly was beneficial but only after effective drainage procedures were done. The patient refused to continue amphotericin B after 5.4 g had been given in two treatments. He became bedridden one year later from back pain that was caused by recurrent disease.

Topics: Abscess; Adult; Amphotericin B; Athletic Injuries; Brain Abscess; Drainage; Football; Humans; Leg Ulcer; Male; Miconazole; Mitosporic Fungi; Mycoses

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Bone Diseases; Diagnosis, Differential; Female; Foot; Humans; Leg Ulcer; Lung Diseases, Fungal; Metatarsus; Osteomyelitis; Penicillins; Radiography; Ulcer

Topics: Amphotericin B; Anemia; Blood Transfusion; Blood Urea Nitrogen; Candida albicans; Candidiasis; Female; Humans; Infant; Iron; Leg Ulcer; Leukocyte Count; Meningitis; Uremia

Topics: Adult; Amphotericin B; Follow-Up Studies; Humans; Iodides; Leg Ulcer; Lung Diseases, Fungal; Male; Occupational Diseases; Ohio; Pneumonectomy; Radiography; Sarcoidosis; Sporothrix; Sporotrichosis; Sputum; Steroids; Tomography; Tuberculosis, Pulmonary; Vegetables

Topics: Amphotericin B; Bone Diseases; Fungi; Humans; Leg Ulcer; Mycoses; Organic Chemicals; Sepsis; Skull; Spinal Diseases; Zygomycosis