[CIS PIDD] [cis-pidd] Majocchi granuloma in a patient with chronic granulomatous disease

[Nacho Gonzalez]

Dear Amy,
Voriconazole levels were tested?
In case of treatment failure with VOR levels within 2-5 ug/ml, keep in mind
that *Penicillium* species are highly susceptible to posaconazole (in fact
it is the most active azol).
Hope it helps
Regards,

Luis Ignacio Gonzalez Granado
Immunodeficiencies. Hospital 12 octubre. Madrid. Spain


2013/4/2 Scurlock, Amy M <ScurlockAmyM at uams.edu>


>  Dear Colleagues:****

>

> ** **

>

> I would appreciate your thoughts and input on a patient in our practice

> with CGD and a new diagnosis of Majocchi granuloma.  The details of the

> case are as follows:  ****

>

> ** **

>

> SM is a 24 y/o male with CGD on chronic sporanox, Bactrim and IFN therapy.

> He presented over one year ago with a small 1 cm dark purple patch on his

> left thigh. The lesion was non-pruritic; however, due to patient’s

> underlying developmental delay (and propensity to pick at any skin lesions)

> the lesion was periodically excoriated with small amount of scab formation.

> Overtime, the lesion grew to its maximum size of 4.5 cm and remained deeply

> violaceous and eroded. The lesion has been biopsied several times with

> results being inconclusive and 2 separate fungal cultures that grew

> penicillium species.  Anti-fungal treatment was switched from sporanox to a

> 3 month course of Lamisil (per ID) from Oct-Dec 2012. He was hospitalized

> in Jan 2013 for community-acquired pneumonia and during the

> hospitalization, both Derm and ID were consulted for another assessment of

> the lesion. His antifungal therapy was subsequently switched to

> Voriconazole. He was on Vori for >10 weeks without change in the lesion. At

> a recent Derm appt, Majocchi granuloma was diagnosed and surgery was

> consulted. The lesion was completely excised by the surgical team last

> week. Cultures and biopsy results are pending.  The agent in most cases is

> trichophyton rubrum but that has not yet been identified in our patient.**

> **

>

> ** **

>

> I would appreciate your thoughts regarding long-term treatment following

> resection and any other experience or recommendations.  ****

>

> ** **

>

> Kindest regards,****

>

> Amy****

>

> ** **

>

> *Amy M. Scurlock, M.D., F.A.A.P*****

>

> Associate Professor, Department of Pediatrics****

>

> Division of Pediatric Allergy/Immunology****

>

> University of Arkansas for Medical Sciences****

>

> Arkansas Children's Hospital****

>

> 13 Children's Way, Slot 512-13****

>

> Little Rock, Arkansas 72202****

>

> Phone: (501) 364-1060****

>

> Fax: (501) 364-3173****

>

> ** **

>

> Confidentiality Notice: This e-mail message, including any attachments,

> is for the sole use of the intended recipient(s) and may contain

> confidential and privileged information.  Any unauthorized review,

> use, disclosure or distribution is prohibited.  If you are not the

> intended recipient, please contact the sender by reply

> e-mail and destroy all copies of the original message.

>

> ---

>

> The CIS-PIDD listserv is supported by:

>

>

> *The science & practice of human immunology*

>

> P: +1.414.224.8095

> E: info at clinimmsoc.org

>

> Not a member of CIS? Please visit www.clinimmsoc.org<https://cis.execinc.com/edibo/Signup>to join!

>

> You are currently subscribed to cis-pidd as: nachgonzalez at gmail.com.

> To unsubscribe click here:

> http://lm.clinimmsoc.org/u?id=183824481.b83ee7e83de457b4848325aafc56219c&n=T&l=cis-pidd&o=43077182

>


---
The CIS-PIDD listserv is supported by the Clinical Immunology Society
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org to join!

You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183939985.3ea13d40a15475ac00ebbd9cd8a37d6d&n=T&l=cis-pidd&o=43077367
or send a blank email to leave-43077367-183939985.3ea13d40a15475ac00ebbd9cd8a37d6d at lists.clinimmsoc.org
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/pipermail/pagid/attachments/20130402/fdb81488/attachment.html>