amphotericin-b and Myositis

Geotrichum capitatum, now known as Blastoschizomyces capitatus, can be responsible for several opportunistic infections (systemic infection or localized at lungs, liver, kidney, encephalitis or meningitis) in an immunocompromised host, especially in those patients affected by leukaemia or under immunosuppressive therapies. A 66-year-old woman with polimyosite under steroid and immunosuppressant therapy was hospitalized in ICU for an acute respiratory distress with moderate hypoxaemia and normocapnia. Pulmonary X-ray revealed a bilateral pneumonia. Hypoxaemia became severe 48 hours later and the patient underwent mechanical ventilation and empirical antibiotic therapy. Blood cultures, urine cultures and serological tests were negative, while yeast was identified by Gram's stain of bronchoaspirate. Before identifying the yeasts Fluconazole was added to therapy. At day 5 the clinical conditions remained severe and Candida spp were excluded: so Fluconazole was switched to liposomal Amphotericin B. At day 8 B. capitatus was identified. At day 26 the patient died of refractory respiratory insufficiency. B. capitatus infection is infrequent and its prognosis is severe, with a high mortality rate (>50%). Microbiological diagnosis requires time to characterize the yeast. At present no standard therapy is available although some authors report a good susceptibility to Amphotericin B and Voriconazole (100%), according to NCCLS guidelines.

Topics: Aged; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Fatal Outcome; Female; Fluconazole; Humans; Immunocompromised Host; Lung Diseases, Fungal; Myositis

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

Topics: Amphotericin B; Arthritis, Infectious; Diagnosis, Differential; Granuloma; Humans; Knee Joint; Male; Middle Aged; Myositis; Sporotrichosis

Topics: Amphotericin B; Animals; Liver Diseases; Male; Mice; Myositis; Sporotrichosis; Temperature