amphotericin-b and Muscle-Weakness

Topics: Adolescent; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Diagnosis, Differential; Flucytosine; Headache; Humans; Male; Meningitis, Cryptococcal; Muscle Weakness

Aspergillosis of the central nervous system is uncommon. It is encountered mainly in the immunocompromised. We describe an unusual case of cerebral aspergillosis in a young but immunocompetent patient. Despite delayed diagnosis, specific anti-fungal therapy lead to a good recovery. Unfortunately, non-adherence with the costly drugs for an adequate period of time was followed by a fatal relapse.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Edema; Female; Humans; Muscle Weakness; Pyrimidines; Seizures; Treatment Outcome; Triazoles; Voriconazole

We describe a case of sporotrichosis that disseminated to involve multiple nerves after initiation of immunosuppressive therapy and then precipitously worsened after withdrawal of therapy. This case illustrates that multiple mononeuropathies are not always caused by vasculitis, and a correct pathological diagnosis should be established before treatment. Based on clinical and pathological features, the mechanism of neuropathy may have been due to either direct nerve infection or a bystander effect of inflammatory/immune damage or, perhaps more likely, to both mechanisms.

Topics: Abscess; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Debridement; Dermatitis; Diagnostic Errors; Disease Progression; Forearm; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Inflammation; Male; Middle Aged; Muscle Weakness; Muscle, Skeletal; Pain; Peripheral Nerves; Peripheral Nervous System Diseases; Sporothrix; Sporotrichosis; Treatment Outcome; Wrist Joint

Infections affecting the central nervous system caused by Blastomyces dermatitidis are rare but curable. We describe a case of a 24-year-old man who presented to the emergency department with progressive bilateral lower extremity weakness over 1 month. On the day of admission, he had minimal muscle strength and was hyperreflexic in the lower extremities. Sensation, however, was intact. Skin examination revealed annular, raised, crusted lesions on his face and legs. A magnetic resonance imaging (MRI) scan showed marrow replacement of the T7 and T8 vertebral bodies and an epidural mass with cord compression. A chest radiograph showed an infiltrate, and a subsequent needle biopsy revealed yeast resembling B. dermatitidis. A skin biopsy was then obtained, and the culture grew out B. dermatitidis. He received 4 weeks of amphotericin B lipid complex (total of 6 grams), followed by oral itraconazole. After 1 week on antifungals, he was able to walk with a walker and the skin lesions virtually resolved. At 5 months he was ambulatory and riding a bicycle daily. Blastomycosis should be included in the differential diagnosis of epidural masses.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomycosis; Diagnosis, Differential; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Muscle Weakness

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Antifungal Agents; CD4 Lymphocyte Count; Histoplasma; Histoplasmosis; Humans; Magnetic Resonance Imaging; Male; Muscle Weakness; Nails; Neurologic Examination; Onychomycosis; Spinal Cord; Spinal Cord Diseases